Prevention of post-operative delirium in older patients with cancer undergoing surgery

Abstract

Post-operative delirium (POD) occurs in as much as 50% of all surgical cancer patients, with older patients being particularly at risk. (1–3) Population aging is a real concern for the surgical oncologists (4) who are treating patients who would not have been considered for surgery in the past. There is a strong association between increasing age, a cancer diagnosis, and the need for surgical intervention. Therefore the identification of pre-surgical risk factors and those patients at higher risk of POD as well as indentifying prophylactic measures aimed at reducing POD emergence, and targeted therapies for POD are especially important. Prevention has been shown to be the most effective strategy for minimizing the occurrence of delirium as well as delirium-associated complications. (5) Therefore prevention of delirium in older adults undergoing surgery is a top research priority given the extent of the problem in this patient population. In this review, we will describe the POD syndrome, previously identified risk factors that predict POD in surgical cancer patients, long-term outcomes of POD and both non-pharmacologic and pharmacologic therapies aimed at preventing POD.

Intensive care unit (ICU) readmission after major lung resection: Prevalence, patterns, and mortality

“…Non‐pharmacologic interventions include increased patient mobilization, reduced sleep disruption, orientation reminders, and increased daily social interaction. Pharmacologic intervention includes antipsychotics, cholinesterase inhibitors, melatonin, and alpha‐2 agonists …”

“…Minor risk factors include polypharmacy, catheterization, use of restraints, malnutrition, and any iatrogenic event. Other risk factors are older age, increased number of comorbidities, increased functional dependency, history of falls in the last six months, presurgical and postsurgical pain, and increased white matter pathology . Hsieh et al .…”

Long-Term Survival in Octogenarians After Surgical Treatment for Colorectal Cancer: Prevention of Postoperative Complications is Key

“…A condition that occurs predominantly in the elderly is the development of postoperative delirium. 36 , 37 During the postoperative period, awareness and measures to prevent postoperative delirium are important, because the occurrence of postoperative delirium can possibly be prevented in a substantial number of the cases. 37 Strategies for screening and correction of polypharmacy, which are associated with an increased risk of delirium, and preventive measures for postoperative delirium should be an integrated part of the surgical treatment of elderly with CRC.…”

Is screening for psychosocial risk factors associated with mental health care in older adults with cancer undergoing surgery?

“…Postoperative delirium is an additional factor that may influence patients' ability to use mental health services. Approximately 15% to 17% of older adults who undergo surgery for cancer experience postoperative delirium; older adults are at a significantly increased risk of delirium compared with younger patients . The preoperative assessment of delirium risk factors (eg, cognitive dysfunction, medical comorbidities, and pain) and the implementation of preventive interventions followed by the assessment and treatment of postoperative delirium are vital components of the medical care of these patients, and also may facilitate patients' ability to engage in needed mental health services postoperatively.…”