Evidence-based strategies to reduce the incidence of postoperative delirium: a narrative review

dc.citation.spage92-101
dc.citation.volume77 Suppl 1
dc.contributor.authorSwarbrick, C. J.
dc.contributor.authorPartridge, J. S. L.
dc.date.accessioned2022-02-28T14:50:12Z
dc.date.available2022-02-28T14:50:12Z
dc.date.epub2022-01-11
dc.date.issued2022-01-11
dc.description.abstractDelirium is one of the most commonly occurring postoperative complications in older adults. It occurs due to the vulnerability of cerebral functioning to pathophysiological stressors. Identification of those at increased risk of developing delirium early in the surgical pathway provides an opportunity for modification of predisposing and precipitating risk factors and effective shared decision-making. No single delirium prediction tool is used widely in surgical settings. Multi-component interventions to prevent delirium involve structured risk factor modification supported by geriatrician input; these are clinically efficacious and cost effective. Barriers to the widespread implementation of such complex interventions exist, resulting in an 'implementation gap'. There is a lack of evidence for pharmacological prophylaxis for the prevention of delirium. Current evidence suggests that avoidance of peri-operative benzodiazepines, careful titration of anaesthetic depth guided by processed electroencephalogram monitoring and treatment of pain are the most effective strategies to minimise the risk of delirium. Addressing postoperative delirium requires a collaborative, whole pathway approach, beginning with the early identification of those patients who are at risk. The research agenda should continue to examine the potential for pharmacological prophylaxis to prevent delirium while also addressing how successful models of delirium prevention can be translated from one setting to another, underpinned by implementation science methodology.
dc.description.admin-noteAccepted version (12 month embargo)
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dc.identifier.citationAnaesthesia. 2022 Jan;77 Suppl 1:92-101. doi: 10.1111/anae.15607.
dc.identifier.doi10.1111/anae.15607
dc.identifier.journalAnaesthesia
dc.identifier.pmid35001376
dc.identifier.urihttps://hdl.handle.net/11287/622367
dc.language.isoeng
dc.publisherWiley
dc.relation.urlhttps://doi.org/10.1111/anae.15607
dc.rights© 2022 Association of Anaesthetists.
dc.subjectanaesthesia for older people
dc.subjectdelirium
dc.subjectgeriatric assessment
dc.subjectperi-operative medicine
dc.subjectpostoperative complications
dc.titleEvidence-based strategies to reduce the incidence of postoperative delirium: a narrative review
dc.typeReview
dc.type.versionppublish
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