Flexible family visitation and postoperative delirium in an orthopedic intensive care unit: A randomized trial examining surgical-type heterogeneity and cost outcomes.

ObjectiveTo evaluate whether flexible family visitation reduces postoperative delirium in older patients admitted to an orthopedic intensive care unit and to explore whether its effects vary by surgical type.MethodsThis single-center, parallel-group randomized controlled trial enrolled patients aged ≥60 years who were admitted to the orthopedic intensive care unit within 24 h following orthopedic surgery. Participants were randomized to daytime flexible family visitation or routine restricted visitation. Delirium during intensive care unit stay was assessed daily using the Confusion Assessment Method for the Intensive Care Unit and the Intensive Care Delirium Screening Checklist. Secondary outcomes included sedative use, hospital-acquired infection, length of stay, and hospitalization costs.ResultsAmong 405 participants, flexible visitation reduced delirium incidence (29.5% vs 44.4%, P = 0.002) and sedative use (32.0% vs 44.9%, P = 0.008). Patients undergoing cervical spine surgery showed the greatest benefit (36.5% vs 57.6%, P = 0.026). Flexible visitation did not increase hospital-acquired infections (3.5% vs 3.9%, P = 0.916) or length of stay (median, 16 days in both groups, P = 0.367) but lowered total hospitalization costs (P < 0.001). Flexible visitation may improve outcomes and reduce costs in high-risk orthopedic intensive care unit patients.ConclusionsFlexible family visitation was associated with lower delirium burden, reduced sedative exposure, and lower hospitalization costs in older orthopedic intensive care unit patients, without increasing infection or prolonging hospitalization. The benefit appeared most pronounced after cervical spine surgery.