The structured implementation of a perioperative brain healthcare bundle and its effectiveness on postoperative delirium incidence

Abstract

BACKGROUND – Postoperative delirium (POD) is a frequent complication after surgery, associated with increased morbidity, prolonged hospital stay, long-term cognitive decline, and healthcare costs. Although evidence-based strategies to reduce POD exist, their implementation in clinical practice remains inconsistent. OBJECTIVES – To assess whether structured implementation of a multicomponent perioperative care bundle is associated with a reduction in POD incidence over time, and to identify key predictors of POD in adult surgical patients. DESIGN – Prospective cohort quality improvement study. SETTING – Single-centre secondary-level care hospital in Switzerland; study period: 6 January 2023 to 6 January 2024. PATIENTS – A total of 1419 adult patients undergoing elective and emergency surgery with postoperative recovery in the postanaesthesia care unit, were included. Patients were enrolled consecutively and included in the final analysis if at least 85% of assessments were completed at four predefined timepoints. The mean age was 58.8years; 726 were male and 693 were female. INTERVENTIONS – Structured implementation of the Safe Brain Initiative perioperative care bundle targeting known POD risk factors. MAIN OUTCOME MEASURES – The primary outcome was the incidence of POD, assessed using a validated screening tool at four postoperative timepoints. Secondary outcomes included identification of independent predictors of POD using logistic regression and propensity score matching. RESULTS – POD was observed in 278 patients (19.6%). An average monthly reduction in POD incidence of 3.52% was observed over the 12-month period. Independent predictors of POD included age >75years, odds ratio (OR) 2.39 (95% confidence interval (CI), 1.58 to 3.62), surgical duration >2h; OR 2.03 (95% CI, 1.45 to 2.85), longer PACU stay; OR 1.05 (95% CI, 1.03 to 1.07), and general anaesthesia; OR 6.50 (95% CI, 3.60 to 11.74). CONCLUSIONS – The structured implementation of the care bundle was associated with a reduction in POD incidence over time. General anaesthesia was the strongest independent predictor. These findings support the use of structured perioperative interventions to mitigate POD risk and warrant confirmation in multicentre studies.