Postoperative delirium: why, what, and how to confront it at your institution

Abstract

Purpose of review:This article reviews the importance of postoperative delirium, focusing on the older surgical population, and summarizes the best-practice guidelines about postoperative delirium prevention and treatment which have been published within the last several years. We also describe our local experience with implementing a perioperative delirium risk stratification and prevention pathway, and review implementation science principles which others may find useful as they move toward risk stratification and prevention in their own institutions.Recent findings: There are few areas of consensus, backed by strong experimental data, in postoperative delirium best-practice guidelines. Most guidelines recommend preoperative cognitive screening, nonpharmacologic delirium prevention measures, and avoidance of deliriogenic medications. The field of implementation science offers strategies for closing the evidence-practice gap, which we supplement with lessons learned from our own experience implementing a perioperative delirium risk stratification and prevention pathway. Summary:Postoperative delirium continues to be a serious perioperative complication commonly experienced by older adults. Growing appreciation of its prognostic implications and evidence behind multidisciplinary, collaborative, and focused prevention strategies rooted in implementation science have prompted several major groups to issue consensus guidelines. Adopting best practices postoperative delirium risk stratification and prevention pathways will improve perioperative care for older adults.

The degree of frailty as a translational measure of health in aging

“…[33][34][35]180 . 212 , including delirium, for example, by applying cognitive screening, physical and social measures for delirium prevention, and reducing medications likely to increase delirium risk 213 . Indeed, understanding the relationship between frailty and delirium, and frailty and dementia, offers a pragmatic means to reduce dementia incidence 214,215 .…”

Preoperative Cognitive Impairment and the Prevalence of Postoperative Delirium in Elderly Cancer Patients—A Prospective Observational Study

“…Highly under-recognised and undiagnosed in elderly patients in the absence of routine monitoring, it has been shown to be potentially preventable in 30–40% of cases. In clinical studies, POD was associated with increased major postoperative complications, persistent neurocognitive disorder, longer hospital stay, higher medical costs, and increased mortality [ 12 , 14 , 15 ]. Cancer patients tend to have a greater risk for POD as a cumulative effect of cancer biology, chronic inflammation, neo-adjuvant treatment, nutritional deficits, stress of diagnosis, and treatment and pharmacologic interactions [ 16 ].…”

Use of Processed Electroencephalography in the Clinical Setting

“…This is unlikely to be a causal relationship and consequently others report no such association, nor benefit from alerts to this situation [ 31 , 32 ]. The reasons for such postoperative morbidity are likely multifactorial and will require a panoply of measures in mitigation [ 33 , 34 •, 35 , 36 ]. Despite little evidence to support pEEG for this goal [ 37 , 38 ], some professional bodies have recommended its use during anesthesia for particular ‘risk’ groups [ 39 – 42 ].…”