POSTOPERATIVE DELIRIUM

A syndrome of acute cognitive failure characterized by a defined clinical features: change in level of consciousness , attention, disturbances of psychomotor, sleep-wake cycle and emotion.

To know:

1. Latest definition of postoperative delirum 
2. Types of POD
3. Recognize the common and severe type of POD
4. Recognize the clinical presentation of POD 
5. Identify high risk population to develop POD.
6. Various management of POD
7. Consequences of POD 

LEARNING POINTS

1. Postoperative delirium is a serious complication that leads to many devastating sequalae.
2. Early recognition and prevention is crucial to minimize further serious consequences such as postoperative cognitive dysfunction, cognitive impairment, dementia and functional dependency.
3. There are many screening tools available to identify those who are at risk.
4. Effective management involves multimodal and multi-disciplinary approach that starts preoperatively.

Postoperative delirium is more frequently seen as more elderly patients present for surgery, emergency, and elective. Elderly patients are at high risk to develop POD. In the latest definition by DSM-V, POD is defined as a syndrome of acute cognitive failure characterized by change in level of consciousness and attention, disturbances of psychomotor, sleep-wake cycle and emotion. There are 3 types of delirium where the hypoactive type is the most common but the least recognized type. Hence, patients suffering from hypoactive delirium are the most risk of high morbidity and mortality. There are multiple risk factors associated with this condition which can be divided to patient factor and surgical factor. To date, there is no specific treatment for POD. The key to minimize and avoid POD is by early prevention and recognition. There are many clinically validated screening tools that are available to help clinician identify patients. Postoperative delirium is associated with high morbidity and mortality. It leads to various if not more serious complications such as increased in length of hospitalization, increased financial burden to patient and healthcare institution, increased functional dependency and development of dementia. Hence, early recognition and intervention is crucial to mitigate delirium sequels. Management of POD starts preoperatively and involves multidisciplinary approach. Enrolling family members into patient management perioperatively helps. Key to successful management of postoperative delirium is to acknowledge that postoperative delirium is a serious postoperative complication that affects high risk group of patients than can lead to devastating complications.

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