American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention

Postoperative delirium is a geriatric syndrome that manifests as changes in cognition, attention, and levels of consciousness after surgery. It occurs in up to 50% of patients after major surgery and is associated with adverse outcomes, including increased hospital length of stay, higher cost of car...

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Published inAnesthesia and analgesia Vol. 130; no. 6; pp. 1572 - 1590
Main Authors Hughes, Christopher G., Boncyk, Christina S., Culley, Deborah J., Fleisher, Lee A., Leung, Jacqueline M., McDonagh, David L., Gan, Tong J., McEvoy, Matthew D., Miller, Timothy E.
Format Journal Article
LanguageEnglish
Published United States International Anesthesia Research Society 01.06.2020
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ISSN0003-2999
1526-7598
1526-7598
DOI10.1213/ANE.0000000000004641

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Summary:Postoperative delirium is a geriatric syndrome that manifests as changes in cognition, attention, and levels of consciousness after surgery. It occurs in up to 50% of patients after major surgery and is associated with adverse outcomes, including increased hospital length of stay, higher cost of care, higher rates of institutionalization after discharge, and higher rates of readmission. Furthermore, it is associated with functional decline and cognitive impairments after surgery. As the age and medical complexity of our surgical population increases, practitioners need the skills to identify and prevent delirium in this high-risk population. Because delirium is a common and consequential postoperative complication, there has been an abundance of recent research focused on delirium, conducted by clinicians from a variety of specialties. There have also been several reviews and recommendation statements; however, these have not been based on robust evidence. The Sixth Perioperative Quality Initiative (POQI-6) consensus conference brought together a team of multidisciplinary experts to formally survey and evaluate the literature on postoperative delirium prevention and provide evidence-based recommendations using an iterative Delphi process and Grading of Recommendations Assessment, Development and Evaluation (GRADE) Criteria for evaluating biomedical literature.
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Perioperative Quality Initiative (POQI) 6 workgroup participants: POQI chairs: Matthew D. McEvoy, MD, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN; Timothy E. Miller, MD, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Tong J. Gan, MD, MHS, FRCA, MBA, Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY. Postoperative Delirium Workgroup: Christopher G. Hughes, MD, MS, Department of Anesthesiology, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Christina S. Boncyk, MD, Department of Anesthesiology, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN; Deborah J. Culley, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, MA; Lee A. Fleisher, MD, Department of Anesthesiology & Critical Care, Penn Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Jacqueline M. Leung, MD, MPH, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA; David L. McDonagh, MD, Departments of Anesthesiology and Pain Management, Neurological Surgery, and Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX. Electroencephalogram Workgroup: Matthew T. V. Chan, MB, BS, PhD, FHKCA, FANZCA, FHKAM, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Traci L. Hedrick, MD, MS, Department of Surgery, University of Virginia Health System, Charlottesville, VA; Talmage D. Egan, MD, Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT; Paul Garcia, MD, PhD, Department of Anesthesiology, Columbia University, New York, NY; Susanne Koch, MD, Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin, Berlin, Germany; Patrick L. Purdon, PhD, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and Department of Anesthesia, Harvard Medical School, Boston, MA; Michael A. Ramsay, MD, FRCA, Department of Anesthesiology and Pain Management, Baylor University Medical Center, Dallas, TX. Spectroscopy Workgroup: Robert H. Thiele, MD, Departments of Anesthesiology and Biomedical Engineering, Divisions of Cardiac, Thoracic, and Critical Care Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA; Andrew Shaw, MB, FRCA, FFICM, FCCM, MMHC, Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada; Karsten Bartels, MD, PhD, Department of Anesthesiology, University of Colorado, Aurora, CO; Charles Brown, MD, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Hilary Grocott, MD, FRCPC, FASE, Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Matthias Heringlake, Department of Anesthesiology and Intensive Care Medicine, University of Lübeck, Germany, Lübeck, Germany.
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ISSN:0003-2999
1526-7598
1526-7598
DOI:10.1213/ANE.0000000000004641