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Postoperative Delirium is defined as an "acute confusional state characterised by inattention, abnormal level of consciousness, thought disorganisation, and a fluctuating course".([FOOTNOTE=Marcantonio, ER & Discussant, SM 2012, Postoperative Delirium, Journal of the American Medical Association, vol. 308, no. 1, pp. 73-81],[ANCHOR=],[LINK=]) The incidence of postoperative delirium in clinical trials varies from 4-66%.([FOOTNOTE=Eide LS, Ranhoff AH, Fridlund B, et al. Comparison of frequency, risk factors, and time course of postoperative delirium in octogenarians after transcatheter aortic valve implantation versus surgical aortic valve replacement. Am J Cardiol. 2015;115(6):802-809.],[ANCHOR=],[LINK=]),([FOOTNOTE=Krzych LJ, Wybraniec MT, Krupka-Matuszczyk I, et al. Detailed insight into the impact of postoperative neuropsychiatric complications on mortality in a cohort of cardiac surgery subjects: a 23,000-patient-year analysis. J Cardiothorac Vasc Anesth. 2014;28(3):448-457.],[ANCHOR=],[LINK=]) Patient-specific and iatrogenic factors may place patients at greater risk.([FOOTNOTE=Yang Y, Zhao X, Dong T, Yang Z, Zhang Q, Zhang Y. Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res. 2017;29(2):115-126.],[ANCHOR=],[LINK=])

Common complications of perioperative care are neurobehavioural disturbances, which can occur in three distinct forms:

  • Emergence Delirium: occurs on emergence from anaesthesia and sedation, with no lucid interval for approximately 30 minutes;
  • Postoperative Cofnitive Decline: subtle cognitive impairment of attention and meomry;
  • Postoperative Delirium: which is the most severe occurs on emergence from anaesthesia and sedation, with or without lucidintervals, for approximately a couple of hours or longer.

Patients suffering postoperative delirium have a 2 to 4 times greater odds of dying in the hospital,([FOOTNOTE=Abelha FJ, Luis C, Veiga D, et al. Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery. Crit Care. 2013;17(5):R257.],[ANCHOR=],[LINK=]),([FOOTNOTE=Veiga D, Luis C, Parente D, et al. Postoperative delirium in intensive care patients: risk factors and outcome. Rev Bras Anestesiol. 2012;62(4):469-483],[ANCHOR=],[LINK=]) 2 times greater odds of dying within 3 months,([FOOTNOTE=Radtke FM, Franck M, Lendner J, Kruger S, Wernecke KD, Spies CD. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth. 2013;110 Suppl 1:i98-105.],[ANCHOR=],[LINK=]) and 2.5 to 5 times greater odds of dying within 6 months compared to patients without postoperative delirium.5,6,([FOOTNOTE=Koster S, Hensens AG, Schuurmans MJ, van der Palen J. Consequences of delirium after cardiac operations. Ann Thorac Surg. 2012;93(3):705-711.],[ANCHOR=],[LINK=])

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BIS™-GUIDED ANESTHESIA

Bispectral index™ guided anesthesia has been demonstrated in multiple randomized-controlled trials to reduce the risk for postoperative delirium.([FOOTNOTE=Chan MT, Cheng BC, Lee TM, Gin T. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013;25(1):33-42.],[ANCHOR=],[LINK=]),([FOOTNOTE=Mei B, Zha H, Lu X, et al. Peripheral Nerve Block as a Supplement to Light or Deep General Anesthesia in Elderly Patients Receiving Total Hip Arthroplasty: A Prospective Randomized Study. Clin J Pain. 2017.],[ANCHOR=],[LINK=]),([FOOTNOTE=Sieber FE, Zakriya KJ, Gottschalk A, et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc. 2010;85(1):18-26.],[ANCHOR=],[LINK=])

CARDIOVASCULAR SURGERY PATIENTS

Cardiovascular surgery patients may be at increased risk for postoperative delirium.2

HIP FRACTURE REPAIR PATIENTS

Increased risk for postoperative delirium has been documented in elderly patients undergoing hip fracture repair.4

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