[Perioperative Neurocognitive Safety - From Evidence-based Delirium Guidelines to Clinical Implementation, Using the...

Postoperative delirium (POD) and perioperative neurocognitive disorders (PND) are among the most common and clinically relevant complications following surgical procedures. Older and vulnerable patients are particularly affected, with reported delirium incidences ranging from 20% to 50%, depending on patient risk profile, surgical procedure, and screening methodology. Beyond increased morbidity and mortality, postoperative neurocognitive complications are associated with functional decline, reduced quality of life, prolonged hospital stays, and substantial healthcare costs.The evidence base for the prevention, early detection, and management of perioperative neurocognitive disorders includes preoperative risk stratification, structured delirium screening, EEG-guided anesthesia, and multimodal perioperative care pathways. These measures are supported by contemporary international recommendations, including the European Society of Anaesthesiology and Intensive Care (ESAIC) guideline on postoperative delirium in adult patients. Despite the growing body of evidence, the successful implementation of these strategies into routine clinical practice remains challenging.This CME article summarizes the current evidence regarding the assessment, prevention, and follow-up of perioperative neurocognitive disorders and discusses the Safe Brain Initiative (SBI) together with its Patient-Centered Precision Care - (PC)² - framework as an example of a structured implementation strategy for evidence-based perioperative care. Three clinical case studies illustrate the practical application of guideline-based recommendations throughout the perioperative pathway. Statements supported by published evidence are clearly distinguished from working hypotheses and implementation concepts whose effectiveness remains the subject of ongoing scientific investigation.