Postoperative Delirium (PD) is common, costly, and often fatal. The etiology of PD is multifactorial and there are multiple risk factors which predispose and precipitate an episode of PD. Predisposing factors are preoperative and may not be modifiable but serve to increase the index of suspicion for diagnosis. Precipitating factors are often iatrogenic. The incidence of PD ranges from 2% for a patient without any risk factors to more than 50% for someone with multiple risk factors. Delirium in general has been shown to have an independent association with poor outcomes including increased hospital mortality rates, nursing home dispositions, length of the hospitalization, and long term mortality. In certain patients aged 65 and older and those undergoing high risk surgeries such as major orthopedic and cardiac surgery, screening for patients at high risk for PD seems prudent. Although there are multiple single component therapies which may help in preventing or minimizing the severity of PD, multicomponent interventions such as a preemptive geriatric or medical consultation, geared to addressing the multifactorial nature of PD, are likely to have the greatest impact on improving postoperative outcomes.
KeywordsPostoperative Delirium Clinical Prediction Rule Confusion Assessment Method Multicomponent Intervention Postoperative Cognitive Dysfunction
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