Citicoline for Delirium Prevention After Hip Surgery: Does It Work?

randomized-controlled-trial PMID: 11784964

Citicoline for Delirium Prevention After Hip Surgery: Does It Work?

Quick Summary: A 2002 study tested citicoline, a supplement that supports brain health, to see if it could prevent confusion (delirium) in older adults having hip fracture surgery. Researchers gave it to some patients before and after surgery, but it didn't lower delirium rates compared to a fake pill. The findings suggest citicoline isn't effective for this use in healthy-brained seniors.

What the Research Found

This randomized trial looked at whether citicoline (also called CDP-choline) could stop or reduce postoperative delirium—a sudden confusion that affects thinking and attention after surgery. Delirium is common in older hip surgery patients and can lead to worse health outcomes.

Key results in simple terms:
- Delirium happened in 17% of patients who got a placebo (fake treatment).
- It occurred in 12% of those who took citicoline.
- The difference wasn't big enough to matter statistically (p=0.6), meaning citicoline didn't prove helpful.
- Daily checks of confusion (using tools like the Confusion Assessment Method and Abbreviated Mental Test) showed no real improvement from citicoline over four days after surgery.
- Overall brain function scores (via Mini Mental State exam) didn't change much in either group before and after surgery.

In short, citicoline didn't prevent or ease delirium in this setup.

Study Details

Who was studied: 81 older adults (average age about 79) getting hip fracture surgery. They had no dementia or other brain diseases beforehand, making the group fairly healthy mentally.
How long: Treatment started 24 hours before surgery and lasted 4 days after, for a total of 5 days. Brain checks happened daily for those 4 post-surgery days.
What they took: Patients got 1.2 grams of citicoline per day through an IV (intravenous drip) or a matching placebo. Half the group (46 people) got the placebo; the other half (35) got citicoline. Neither patients nor doctors knew who got what (double-blind).

The study used stats like chi-square and Wilcoxon tests to compare groups, with a cutoff of p<0.05 for "significant" results—none were met here.

What This Means For You

If you're an older adult facing hip surgery or caring for someone who is, this study shows citicoline likely won't help prevent post-surgery confusion. Delirium affects 40-50% of elderly hip fracture patients and raises risks like longer hospital stays or death, so focus on proven steps instead:
- Talk to your doctor about pain control, staying hydrated, and getting moving soon after surgery.
- Keep a calm environment and involve family to reduce stress.
- Don't start citicoline on your own for this—it's not backed here, and more research is needed for other brain benefits like memory support.

Always check with a healthcare pro before trying supplements, especially around surgery.

Study Limitations

This research has some gaps that mean it's not the final word:
- Small group size: Only 81 people total, which might miss smaller benefits of citicoline.
- Short timeframe: Just 5 days of treatment—longer use might act differently, but we don't know.
- Who was left out: Results apply only to those without dementia or brain issues; if you have mild cognitive problems, it might not fit you.
- Older study: From 2002, so it doesn't reflect today's surgery techniques or drugs that might change delirium risks.
- Test tools: The confusion checks (like CAM) might not catch every subtle sign, possibly underestimating effects.

Bigger, newer studies could clarify if citicoline helps in other ways or groups.

Key Findings

This 2002 randomized controlled trial (RCT) found that citicoline (CDP-choline) did not significantly reduce the incidence of postoperative delirium in elderly patients undergoing hip fracture surgery. Delirium occurred in 17.39% of placebo recipients versus 11.76% in the citicoline group (p=0.6), with no statistically significant differences in Confusion Assessment Method (CAM) or Abbreviated Mental Test (AMT) scores post-surgery.

Study Design

The study was a double-blind RCT involving 81 patients aged ≥65 years (mean age: 79.45 in citicoline group, 79.97 in placebo group) undergoing hip fracture surgery. Participants were excluded if they had dementia or organic brain disease. Citicoline (1.2 g/day) or placebo was administered 24 hours pre-surgery and continued for 4 postoperative days. Delirium was assessed using AMT and CAM daily for 4 days post-surgery. Cognitive function was evaluated via Mini Mental State (MMS) scores pre- and post-treatment.

Dosage & Administration

Citicoline was administered intravenously at 1.2 g/day, starting 24 hours before surgery and continuing for 4 consecutive days post-surgery. The placebo group received a visually identical intravenous solution without active ingredients.

Results & Efficacy

Delirium Incidence: 11.76% (4/34) in citicoline group vs. 17.39% (8/46) in placebo (p=0.6, chi-square test).
CAM Scores: No significant differences between groups at days 1–4 post-surgery (p=0.8).
AMT Scores: No significant differences observed (p=0.34).
Cognitive Function (MMS): No significant changes reported pre- to post-surgery between groups.
The results indicate no efficacy of citicoline in preventing delirium or cognitive decline in this population.

Limitations

Small Sample Size: Only 81 patients (35 citicoline, 46 placebo) may have limited statistical power to detect modest effects.
Short Duration: Treatment lasted just 5 days (pre- and post-surgery), potentially insufficient for long-term cognitive outcomes.
Exclusion Criteria: Findings may not generalize to patients with dementia, cognitive impairment, or other brain pathologies.
Assessment Tools: CAM and AMT may lack sensitivity for detecting subtle delirium changes compared to more detailed diagnostic criteria.
Outdated Methodology: Conducted in 2002, with no recent replication to assess modern surgical or anesthetic practices.

Clinical Relevance

This study does not support the use of citicoline (1.2 g/day IV) for delirium prevention in elderly patients undergoing hip fracture surgery. While delirium rates were numerically lower in the citicoline group, the difference was not statistically significant. Clinicians should prioritize established delirium prevention strategies (e.g., pain management, hydration, early mobilization) over citicoline for this indication. Further research with larger samples, longer follow-up, and broader patient populations is needed to confirm these findings.

Citicoline for Delirium Prevention After Hip Surgery: Does It Work?