Postoperative delirium – treatment and prevention

Abstract

Purpose of review Postoperative delirium (POD) is one of the most severe complications after surgery. The consequences are dramatic: longer hospitalization, a doubling of mortality and almost all cases develop permanent, yet subtle, cognitive deficits specific to everyday life. Actually, no global guideline with standardized concepts of management exists. Advances in prevention, diagnosis and treatment can improve recognition and risk stratification of delirium and its consequences. Recent findings Management of POD is a multiprofessional approach and consists of different parts: First, the detection of high-risk patients with a validated tool, preventive nonpharmacological concepts and an intraoperative anesthetic management plan that is individualized to the older patient (e.g. avoiding large swings in blood pressure, vigilance in maintaining normothermia, ensuring adequate analgesia and monitoring of anesthetic depth). In addition to preventive standards, treatment and diagnostic concepts must also be available, both pharmaceutical and nonpharmacological. Summary Not every POD can be prevented. It is important to detect patients with high risk for POD and have standardized concepts of management. The most important predisposing risk factors are a higher age, preexisting cognitive deficits, multimorbidity and an associated prodelirious polypharmacy. In view of demographic change, the implementation of multidisciplinary approaches to pharmacological and nonpharmacological POD management is highly recommended.

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.…”

Post-Operative All-Cause Mortality in Elderly Patients Undergoing Abdominal Emergency Surgery: Role of Charlson Comorbidity Index

“…The latter data suggest that perioperative complications should include acute medical conditions in addition to surgical ones in aged. Moreover, in older adults a further severe complication should be considered after surgery, that is post-operative delirium [ 4 ]. Its consequences are longer hospitalisation, a doubling of mortality and almost all cases develop permanent, yet subtle, cognitive deficits specific to everyday life [ 4 ].…”

“…Moreover, in older adults a further severe complication should be considered after surgery, that is post-operative delirium [ 4 ]. Its consequences are longer hospitalisation, a doubling of mortality and almost all cases develop permanent, yet subtle, cognitive deficits specific to everyday life [ 4 ]. In 2018, Eamer et al [ 5 ] reviewed risk assessment tools in studies on elderly surgical patients, and they concluded that the majority of them are not commonly used for pre-operative risk assessment.…”

Incidence, Outcome And Risk Factors of Postoperative Delirium Subtypes, A Systematic Review And Meta-Analysis

“…Therefore, corresponding measures should be taken to modify risk factors, such as reducing perioperative blood loss [31,32], shortening the duration of anesthesia and surgery as much as possible, controlling in ammatory reactions to reduce the level of in ammatory factors [33][34][35]. In addition, for hyperactive delirium, the risk factor is pain, for which appropriate management could be taken to relieve the pain of the patients [36][37][38][39]. For hypoactive delirium, preoperative use of β-blocker drugs can signi cantly reduce the incidence of hypoactive delirium after surgery.…”