Recent Advances in Preventing and Managing Postoperative Delirium

Area of Science:

• Geriatric Medicine
• Neuroscience
• Anesthesiology

Background:

• Postoperative delirium is a frequent complication in elderly surgical patients, with higher risk in those with pre-existing cognitive impairment or dementia.
• Delirium may accelerate cognitive decline and dementia onset or progression.
• Despite increased awareness and prevention initiatives, delirium pathophysiology remains poorly understood, leading to limited evidence for perioperative guidelines.

Purpose of the Study:

• To review the current understanding of the neurobiology of postoperative delirium.
• To summarize existing prevention and management strategies for postoperative delirium.

Main Methods:

• Narrative review of existing literature on postoperative delirium.
• Examination of neurobiological underpinnings.
• Summary of current prevention and management efforts.

Main Results:

• Inconsistent findings from recent trials on pharmacologic prevention (ketamine, dexmedetomidine).
• Non-pharmacologic multicomponent interventions (e.g., Hospital Elder Life Program) show consistent reductions in delirium incidence.
• A significant portion of delirium cases remain unprevented, necessitating further research.

Conclusions:

• Effective prevention and management strategies are crucial to complement non-pharmacologic therapies.
• Further research into delirium neurobiology is needed to improve evidence-based perioperative care.
• There is an ongoing need for improved strategies to address postoperative delirium in older adults.