Prediction and Prevention of Postoperative Delirium in Older Patients

Abstract

<strong>Introduction:</strong> <br/> Postoperative delirium (POD) is a common and serious complication associated with increased morbidity, prolonged hospital stays, institutionalization, and elevated mortality rates. Early identification of patients at risk is essential, particularly in resource-constrained healthcare systems, to enable the timely implementation of targeted preventive interventions. Among others, age and alcohol drinking are predisposing factors for postoperative delirium (POD). Detailed patient data of the PROPDESC study (PRe-Operative Prediction of postoperative DElirium by appropriate SCreening) allows various ways to identify patients at risk for POD. Postoperative measures like early re-orientation, mobilisation or sleep routine, can be initiated to prevent POD after surgeries. <br/> <strong>Methods: </strong> <br/> This doctoral thesis consists of five publications of three different prospective clinical trials, covering the process of delirium prediction and delirium prevention in the perioperative process. Aiming to determine easy and accurate ways to identify patients at-risk at an early stage and prevent the occurrence of postoperative delirium. The use of a preoperative risk score is examined. Impact of preoperative blood values and alcohol consumption are evaluated. In the postoperative setting, a measure for delirium prevention in cardiac surgery patients was tested. <br/> <strong>Results:</strong> <br/> Various preoperative routine blood values could be used together with the PROPDESC risk score to identify patients at risk for POD. The AUDIT-C is an accurate tool to assess the additional risk factor alcohol consumption. Postoperatively Snoezelen could reduce the incidence of POD in cardiosurgical patients significantly. <br/> <strong>Conclusion:</strong> <br/> As POD is a severe, but often underrated adverse event, a synthesis of prediction through early identification and prevention via optimization of the perioperative process is needed to reduce the incidence of this event. The implementation of accurate prediction tools and suitable prevention measures in the perioperative routine could reduce the burden of this syndrome.