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[Perioperative Neurocognitive Safety - From Evidence-based Delirium Guidelines to Clinical Implementation, Using the
Summary
Postoperative delirium (POD) and perioperative neurocognitive disorders (PND) affect many patients, especially older adults, leading to poor outcomes. Evidence-based strategies and structured implementation like the Safe Brain Initiative can improve care.
Area of Science:
- Anesthesiology
- Geriatrics
- Neuroscience
Background:
- Postoperative delirium (POD) and perioperative neurocognitive disorders (PND) are common complications, particularly in older patients, with incidences from 20% to 50%.
- These disorders increase morbidity, mortality, functional decline, reduce quality of life, prolong hospital stays, and raise healthcare costs.
Purpose of the Study:
- To summarize current evidence on assessing, preventing, and managing PND.
- To discuss structured implementation strategies for evidence-based perioperative care, using the Safe Brain Initiative (SBI) and its (PC)² framework as examples.
Main Methods:
- Review of current evidence on PND assessment, prevention, and follow-up.
- Discussion of international recommendations (e.g., ESAIC guideline).
- Presentation of clinical case studies illustrating guideline application.
Main Results:
- Evidence supports preoperative risk stratification, delirium screening, EEG-guided anesthesia, and multimodal care pathways for PND management.
- Implementation of these strategies into routine practice remains a challenge.
Conclusions:
- Evidence-based strategies exist for PND prevention and management, supported by international guidelines.
- Structured implementation frameworks like the Safe Brain Initiative are crucial for translating evidence into clinical practice.
- Further research is needed for implementation concepts whose effectiveness is still under investigation.