A new large-scale study has highlighted postoperative delirium as a preventable and high-impact complication, primarily driven by patient frailty and surgical stress. The study, published in JAMA Network Open, emphasizes that this condition can be mitigated through low-cost, evidence-based interventions. The findings urge clinicians, health systems, patients, and families to prioritize brain health throughout perioperative care.
Postoperative delirium is not a minor complication; it is akin to acute brain failure, a medical emergency that demands immediate recognition and intervention. According to the study’s senior author, Laurent Glance, MD, professor of Anesthesiology and Perioperative Medicine at the University of Rochester Medical Center (URMC), “Postoperative delirium affects roughly one in 30 older adult patients, significantly increasing their risk for poor outcomes. Simple, cost-effective strategies can curb the downstream costs and suffering associated with this condition.”
Delirium’s Impact and Opportunity for Prevention
Postoperative delirium manifests as a sudden, often temporary state of confusion following surgery. It involves disorganized thinking, inattention, and changes in alertness, predominantly affecting older adults. Reported rates vary widely, from less than one percent to as high as 50 percent, depending on the type of surgery and hospital practices.
Once considered minor and self-resolving, delirium is now associated with severe consequences, including long-term cognitive decline and increased need for nursing home care. The condition also imposes a substantial financial burden, with estimated annual costs ranging from $26 billion to $42 billion in U.S. healthcare expenses.
Utilizing Medicare claims data from 2017 to 2020, researchers analyzed over 5.5 million hospitalizations for adults aged 65 and older who underwent major non-cardiac surgery under general anesthesia. They identified postoperative delirium in 3.6 percent of cases. Compared to patients without delirium, affected individuals faced:
- 3.5 times higher odds of death or major complications
- 2.8 times higher odds of dying within 30 days
- 4 times higher odds of being discharged to a facility rather than home
Factors contributing to higher incidences of postoperative delirium include frailty, comorbidities, disease severity, and the complexity of the surgery.
Low-Cost, High-Yield Interventions
“Postoperative delirium is a preventable—not inevitable—complication,” stated Heather Lander, MD, an associate professor of Anesthesiology and Perioperative Medicine at URMC and the study’s first author. “With proper resources, education, and systematic workflows, health institutions can improve quality of life and patient-centered outcomes, while also reducing length of stay, complications, deaths, and financial burden.”
The study identifies several measures to mitigate the risk of delirium:
- Sleep hygiene: Cluster vital checks, labs, and medication administration to minimize nighttime disturbances during hospitalization.
- Sensory support: Ensure patients have and use glasses and hearing aids (with extra batteries) to maintain orientation.
- First-case scheduling for high-risk patients: Reduce prolonged fasting and circadian disruption by scheduling surgeries early in the day.
- Early geriatric or hospital-medicine co-management: Involve specialists to optimize medical and functional status before and after surgery.
The authors stress the importance of educating patients and families about delirium risks and prevention tactics, such as maintaining familiar surroundings and preserving normal sleep patterns, to empower them to recognize warning signs and advocate for early intervention.
Broader Implications and Future Directions
This study was conducted with contributions from Karen Joynt Maddox, Mark Oldham, Stewart Lustik, Marjorie Gloff, Jacob Nadler, Isaac Wu, and Raymond Zollo from URMC, Andrew Dick from Washington University, Lee Fleisher from the University of Pennsylvania, Michael Mazzeffi from the University of Virginia, and Jingjing Shang and Patricia W. Stone from Columbia University. It was supported by funding from the National Institute on Aging, the National Institute of Nursing Research, and the URMC Department of Anesthesiology and Perioperative Medicine.
The findings underscore the critical need for healthcare systems to implement these low-cost interventions to improve patient outcomes significantly. As the population ages, the incidence of surgeries among older adults is expected to rise, making the prevention of postoperative delirium more pertinent than ever. Moving forward, integrating these strategies into standard perioperative care could transform patient experiences and healthcare costs on a national scale.
