Early postoperative cognitive decline—are there any preventive strategies for surgical patients in the emergency setting?

Abstract

Postoperative neurocognitive impairments following surgery are a growing concern, especially in the elderly population, since it is associated with a significantly increased risk of morbi-mortality in the postoperative period. Among them, delirium or the early postoperative cognitive decline is associated with a further risk of prolonged cognitive dysfunction and it may quicken long-term cognitive impairment or postoperative cognitive dysfunction (POCD). The current knowledge regarding preventive strategies for delirium is not focused anymore only on pharmacological and behavioral management strategies in the postoperative period, but also supports the preoperative cognitive training programs. Since preoperative cognitive evaluation and proactive interventions to optimize surgical patient outcomes are rather impossible in the emergency setting, what are the appropriate preventive strategies that can be implemented in day-to-day practice? In this review, we try to highlight the most recent experimental and clinical strategies, and outline the most relevant recommendations for clinicial practicioners based on the available data.