Occurrence of Postoperative Delirium and the Use of Different Assessment Tools

Area of Science:

• Gerontology
• Critical Care Medicine
• Neuroscience

Background:

• Postoperative delirium (POD) significantly increases patient morbidity and healthcare costs.
• Standardized assessment and prevention strategies for POD are recommended by leading clinical guidelines.
• Early identification of POD is crucial for timely intervention and improved patient outcomes.

Purpose of the Study:

• To compare the efficacy of different delirium assessment tools in the postoperative period.
• To analyze the frequency and timing of POD development over the first five postoperative days.
• To evaluate the performance of the Confusion Assessment Method (CAM), 4 A's Test (4AT), and Delirium Observation Screening (DOS) scale.

Main Methods:

• Prospective observational study including 1097 patients at a university hospital.
• Utilized CAM-ICU/CAM, 4AT, and DOS scale for POD assessment over five consecutive postoperative days.
• Subgroup analysis from the PRe-Operative Prediction of Postoperative DElirium by Appropriate SCreening (PROPDESC) trial.

Main Results:

• The majority of new POD cases emerged on the first and second postoperative days.
• No single POD assessment tool demonstrated superior performance for definitive recommendation.
• POD occurrence peaked within the initial 48 hours post-surgery.

Conclusions:

• Postoperative delirium assessment is recommended for the first five days, with highest incidence in the first two days.
• Assessment tools incorporating direct patient questioning and observation are advisable.
• Further research may be needed to identify the optimal POD screening tool for clinical practice.