[Post-operative delirium of the elderly patient--an iceberg?]

Post-operative delirium is common, and has an incidence of 37-74% as reported in different publications. The growing rates of the elderly among surgical patients makes that condition more relevant than ever, since these populations are highly susceptible to develop this condition. Contrary to the common assumption, delirium is not a unique complication of the elderly alone. Trauma and young surgical patients may also present its manifestations after major and complicated surgery in the different intensive care units. Post-operative delirium was shown to precede long term complications such as dementia. Many of the patients that develop delirium will be sent to long and complicated rehabilitation units, after being reLeased from hospitalization, thus increasing the economic burden on the medical system. Furthermore, the once recognized "ICU Psychoses" are no longer exclusive to intensive care units alone, and nowadays, infiltrate to all surgical departments. Simple, bedside clinical tools were developed, for rapid diagnoses of post-operative delirium. Adequate and on time diagnosis of this condition is crucial in the surgical patient, as it may be the only sign that predicts other severe surgical complications. This review exposes aspects of post-operative delirium in the elderly patient. Diagnostic modalities, as well as current management recommendations are discussed.