Postoperative delirium: from bundles to precision prevention

Area of Science:

• Gerontology
• Neuroscience
• Anesthesiology

Background:

• Perioperative brain health, including postoperative delirium (POD) and cognitive decline, is a critical patient safety concern in older surgical patients.
• The term perioperative neurocognitive disorders now encompasses pre-existing conditions, POD, delayed recovery, and postoperative neurocognitive disorder.
• POD incidence varies, but its impact is significant, leading to increased mortality, longer hospital stays, and cognitive deterioration.

Purpose of the Study:

• To review the current state of perioperative brain health management.
• To identify gaps in screening, prognostic modeling, and vulnerability assessment for precision prevention.
• To outline future directions for research and clinical implementation.

Main Methods:

• Review of current literature and clinical guidelines on perioperative brain health.
• Analysis of the limitations of existing screening uptake and prevention bundles.
• Evaluation of the role of biomarkers and physiological monitoring.

Main Results:

• Screening for POD and cognitive dysfunction is underutilized (<10% in many areas).
• Multicomponent, non-pharmacological bundles are recommended but face implementation challenges.
• Gaps exist in standardized vulnerability assessment (frailty, malnutrition) and prognostic model transportability.
• Biomarkers and EEG monitoring may refine risk but are not stand-alone solutions.

Conclusions:

• Achieving "precision prevention" for perioperative neurocognitive disorders requires addressing implementation gaps.
• Future research must standardize vulnerability phenotyping and integrate monitoring into scalable workflows.
• Translating guidelines into practical bedside actions is essential for improving perioperative brain health.