Haloperidol Use Among Elderly Patients Undergoing Surgery: A Retrospective 1-Year Study in a Hospital Population

BACKGROUND: Haloperidol, frequently used for delirium, can lead to serious side effects, of which QTc prolongation is the most worrisome since it is associated with an increased risk of fatal cardiac arrhythmia. OBJECTIVES: The aim of this study was to measure the frequency of haloperidol use after procedures in patients aged ≥65 years in a hospital in the Netherlands. METHODS: This was a retrospective study among patients hospitalized in the Netherlands who were aged ≥65 years and who underwent a procedure between January 2008 and January 2009. The hospital’s electronic drug database was used to identify the use of haloperidol during hospital admission. RESULTS: A total of 7782 procedures took place in 5946 elderly patients, and 1357 patients were readmitted for a second procedure in the same year. The overall frequency of haloperidol use was 5.4 %. Procedures were classified as elective (90 %) and as major (18 %). A total of 28 % (n = 570) of patients who underwent acute procedures and 24 % (n = 1086) of patients who underwent major procedures received haloperidol. Patients receiving haloperidol had a significantly longer hospital stay (14 vs. 1 day, p < 0.001) than patients without haloperidol. Haloperidol users were more likely to have more than one intervention than non-users (16.0 vs. 1.7 %, p < 0.001). In multivariable analysis, haloperidol use was associated with older age (odds ratio [OR] 1.09; 95 % confidence interval [CI] 1.07–1.11, p < 0.001), acute surgery (OR 2.09; 95 % CI 1.65–2.94, p < 0.001), and major procedures (OR 15.4; 95 % CI 11.5–21.5, p < 0.001). CONCLUSION: We show a frequency of haloperidol use of 5.4 %. Based on this high frequency, surveillance of adverse events in hospital should be performed systematically, particularly in the high-risk population that undergoes acute major surgery.