Predicting delirium: are we there yet?

Postoperative delirium is an extremely common complication after all types of surgery in the elderly, with an incidence as high as 65% in patients admitted for hip fracture repair.¹ The implications of an episode of delirium are serious and include an increased risk of dementia, increased length of stay, increased costs, and increased risk of mortality.¹ Delirium is associated with progression of cognitive decline even in those with normal baseline cognition.² It is widely acknowledged that delirium is a preventable complication, with the Australian Council for Safety and Quality in Health Care (ACSQHC), the National Institute for Health and Clinical Excellence (NICE, UK),³ and the American Society of Anesthesiologists (ASA) defining risk-prevention models for implementation in all hospitals. In Australia, the ACSQHC 'Cognitive Care' package⁴ has been distributed as a set of Clinical Care Standards highlighting the importance of preoperative cognitive assessment; NICE in the UK includes similar Clinical Guidelines; while in the USA, the ASA has commenced the 'Brain Health Initiative'.⁵ These organizations have developed guidelines for identifying at-risk patients, strategies for prevention, and for targeting research areas specific to reducing delirium.

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