Postoperative delirium occurs between 3% and 45% of patients undergoing general or local anaesthesia for an operation.

It is usually associated with a worsening of the clinical course with an increased length of stay and cardio-respiratory complications during hospitalisation, but also an increased risk of cognitive dysfunction and mortality in the 12 months following surgery.

The Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences of Sapienza University of Rome and the Department of Anaesthesiology, Critical Care and Pain Medicine of Policlinico Umberto I General Hospital, in collaboration with the University of Tor Vergata and the University of Florence, conducted a systematic search for clinical evidence on the risk factors of postoperative delirium published in indexed scientific journals.

Researchers have quantitatively identified which factors are associated with an increased risk of developing this serious complication. The results of the review article were published in the prestigious British Journal of Anaesthesiology and will be used for the new guidelines of the European Society of Anaesthesiology and Intensive Care (Esaic).

The risk factors were structured in three stages, according to when they can be recognised and recorded: preoperative, intra-operative and postoperative risks. The meta-analysis revealed that older age, comorbidities, and preoperative cognitive function are most relevant in the development of postoperative delirium.

"The application of a screening based on the indications presented in this study will allow medical and nursing staff involved in preoperative management," says Lior Mevorach and Ali Forookhi of the Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences of Sapienza University and the Department of Anaesthesiology, Critical Care and Pain Medicine of Policlinico Umberto I General Hospital " to identify the presence of high-risk patients and to implement therapeutic initiatives (pharmacological and non-pharmacological) effective in neutralising the excess risk".

"Our hope," concludes Lior Mevorach, first author of the review article, "is that the innovative methodology of our work and the evidence we have found will help set new standards in the quality of clinical management of patients".

References:

Perioperative risk factors associated with increased incidence of postoperative delirium: systematic review, meta-analysis, and Grading of Recommendations Assessment, Development, and Evaluation system report of clinical literature – Lior Mevorach, Ali Forookhi, Alessio Farcomeni, Stefano Romagnoli, Federico Bilotta - British Journal of Anaesthesia (2022) https://doi.org/10.1016/j.bja.2022.05.032

Further Information

Federico Bilotta
Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I
federico.bilotta@uniroma1.it