Postoperative delirium in older adults: a surgeon’s guide and clinical practice review

Abstract

Postoperative delirium (POD) is an acute change in mental status following surgery or a procedure. POD is the most common postoperative complication in older adult patients. As the population ages and more older adults choose to undergo operations, recognition and management of POD is becoming increasingly important to patients and to health systems. Factors that contribute to POD span many domains, including but not limited to medications, infections, immobilization, and metabolic derangements. Prevention is central to management; evidence-based strategies include adequate pain control, infection prevention, good sleep hygiene, optimization of hearing and vision, consistent re-orientation to time and place, and frequent mobilization. In patients who experience POD, interdisciplinary care focused on re-orientation, medication management, and sleep hygiene has been successful. It also is important to limit use of antipsychotic or sedative medications whenever possible—although sometimes successful in controlling dangerous behavior, these medications prolong and do not prevent delirium. POD can lead to delayed surgical healing, prolonged hospital stays, long-term cognitive dysfunction, and substantial healthcare costs. It is thus important that healthcare providers understand how to prevent, recognize, and treat POD. This review summarizes the incidence and risk factors, presentation and diagnosis, prevention, management, and broader impact of POD.