Postoperative Delirium Prevention and Management

Introduction to Postoperative Delirium

Postoperative delirium occurs in approximately 18-50% of surgical patients, with higher rates after cardiac surgery, and is associated with increased mortality, prolonged cognitive impairment, and reduced functional recovery 1, 2, 3, 4, 5, 6

Advanced age is a significant risk factor, with patients 65-85 years having 2.67 times the odds and those over 85 having 6.24 times the odds of developing postoperative delirium 4, 5, 6
Pre-existing cognitive impairment or dementia increases the odds by 3.99 times 4, 5, 6
History of prior delirium increases the odds by 3.9 times 4, 5, 6
Male sex is a risk factor 3, 4, 6
Low BMI (BMI <18.5) increases the odds by 2.25 times 4, 5, 6
Lower educational level is a risk factor, with a college degree being protective (OR 0.45) 3, 4, 5, 6

The American Society of Anesthesiologists recommends systematic screening for delirium at least once per nursing shift using validated tools like the Confusion Assessment Method (CAM) for general ward patients and CAM-ICU for intensive care patients 1, 2, 7

The American College of Surgeons recommends multimodal opioid-sparing analgesia, including acetaminophen, tramadol, dexmedetomidine, and pregabalin or gabapentin, to reduce the risk of delirium 1, 2
Early mobilization, reorientation techniques, sleep hygiene, and avoiding hypothermia are recommended as nonpharmacologic strategies to prevent delirium 1, 2, 8
Avoiding benzodiazepines and anticholinergic medications is recommended to reduce the risk of delirium 10, 8

The Society of Critical Care Medicine recommends treating the underlying cause of delirium rather than just the symptoms, and using nonpharmacologic interventions as first-line treatment 1, 2, 7
Low-dose oral antipsychotics may be effective when pharmacologic treatment is needed, but should be used with caution 1, 2

Postoperative delirium is associated with lasting cognitive consequences, including a trajectory of initial severe decline followed by prolonged impairment, and some studies show cognitive changes persisting up to 7.5 years after surgery 10