Postoperative delirium: perioperative assessment, risk reduction, and management

Abstract

Postoperative delirium is a relatively common and serious complication. It increases hospital stay by 2e3 days and is associated with a 30-day mortality of 7e10%. It is most prevalent in older patients, those with existing neurocognitive disorders, and those undergoing complex or emergency procedures. Preclinical and clinical research in recent years has uncovered more about the pathophysiology of postoperative delirium and may yield more potential therapeutic options. Using the enhanced recovery pathway framework of risk stratification, risk reduction, and rescue treatment, we have reviewed the current clinical evidence on the validity of delirium prediction scores for the surgical population, the effectiveness of perioperative delirium risk reduction interventions, and management options for established delirium. Effective perioperative interventions include depth of anaesthesia monitoring, intraoperative dexmedetomidine infusion, and multimodal analgesia. Choice of general anaesthetic agent may not be associated with significant difference in delirium risk. Several other factors, such as preoperative fasting, temperature control, and blood pressure management have some association with the risk of postoperative delirium; these will require further studies. Because of the limited treatment options available for established delirium, we propose that risk assessment and perioperative risk reduction may be the most effective approaches in managing postoperative delirium.

A Randomised Trial: BIS-Guided Anesthesia Decreases The Incidence of Delayed Neurocognitive Recovery And Postoperative Neurocognitive Disorder But Not Postoperative Delirium

“…Morbidity of POD is 19.6% in the control group, which was consistent with L.Evered's result [13] (15-53%), and it occurred mainly in the rst three days [34] due to the effects of anxiety, pain [35] , and residual anesthetic. However, there was no signi cant statistical difference in this study.…”

The risk factors of postoperative delirium in general anesthesia patients with hip fracture

“…[ 8 , 9 ] Postoperative delirium can exacerbate the condition and increase the risk of pulmonary infections, electrolyte disturbances, deep vein thrombosis, and falls, thus prolonging the length of hospital stay, increasing the cost, and burdens of patients and society. [ 10 , 11 ] It is been reported that the mortality of patients with delirium after hip fracture surgery increased by about 3 times compared with patients without delirium in 6 months after surgery. [ 12 ] Therefore, the management of delirium after hip fracture surgery is essential to the prognosis of patients.…”

Perioperative Vascular Biomarker Profiling in Elective Surgery Patients Developing Postoperative Delirium: A Prospective Cohort Study

“…Although still elusive, the underlying factors in the pathogenesis of POD appear to be numerous. Patient age and gender, preexisting cognitive decline, comorbidities including (among numerous others) alcohol abuse, diabetes, and hypertension, and emergency surgery were identified as predisposing factors that might not or at least might not be significantly influenced [ 1 ]. In contrast, precipitating factors such as perioperative pharmacological and anesthesiological management, extent and invasiveness of surgical measures, and preservation of fluid and temperature homeostasis can be actively controlled, thereby offering the chance to reduce the risk for POD development.…”

“…Since the prevalence of POD is known to increase with patient age, and the average age of the general surgical patient population likewise increases, so does the incidence of POD. Comorbidities and the type of surgery do have a further impact, resulting in a statistical risk for POD ranging from 2.5% in the general surgical population up to 70% in patients requiring emergency femur fracture repair [ 1 ]. POD is characterized as cognitive impairment with an acute and fluctuating disturbance in awareness and attention, appearing in either hyper- or hypoactive manifestation or a combination of both [ 2 ].…”