Postoperative confusion: Is the elderly screened for delirium after every operation? - German Medical Journal

Delirium after surgery is not just a temporary side effect, as the term "transit syndrome" implies.On the contrary, it is a risk of permanent discomfort that not only affects the success of the operation, but also the quality of life of those affected.

On the one hand, surgical specialists consider delirium to be a major problem in the care of elderly people, but on the other hand, it is the least understood condition of elderly patients.As surgical disciplines increasingly recognize how delirium can affect the success of operations, it is important that they are able to identify risk groups better than before.

Not enough testing has been done in the elderly

The working group around Prof. Dr. Med.Gabriel Hundeshagen, head of burn surgery at BG Clinic Ludwigshafen, retrospectively analyzed data from 217,783 adult surgical patients from 2021 to 2023 from an American study group (1).Among those aged ≥75 years, a total of 46.1% were screened for postoperative delirium.With increasing age, screening was more frequent.However, the share remained below 60% even in the highest age groups.Within the study groups, the prevalence of delirium increased significantly with age (75–79 years: 7.2%; 80–84 years: 10.1%; 85–89 years: 15.2%; ≥ 90 years: 22.8%. Overall, about one in 10 examined patients (10.6%) was diagnosed with delirium.

Anyone who developed delirium should expect significant losses: regardless of other influencing factors, this condition was associated with a 3-fold higher mortality in the first month after the procedure (odds ratio [OR] 3.2; 95% confidence interval [CI] 2.9–3.5);The rate of reoperation was twice as high (OR 2.3; CI 2.1-2.5);Surgical complications were also more common (OR 1.8; CI 1.7-1.9).In addition, affected individuals were less likely to be discharged home (OR 0.5; CI 0.4-0.5).

Evidence of a particularly high-risk group of astronauts can be identified: those affected by dementia tend to be slightly older (81.3 vs. 79.9 years on average) and more likely to have dementia (37.5% vs. 7.9%).In addition, a history of falls is often associated with postoperative amnesia (40% vs. 18%);as well as the urgency of the procedure or emergency surgery (55% vs. 26%).The duration of the operation also plays a role: every 10 minutes longer is associated with a 2.3% higher risk of amnesia.

"We were surprised that delirium had such a negative impact on surgical outcomes," study leader Henderhagen explained. "It was even more surprising that a condition associated with high risk was treated so seriously," the surgeon commented. For example, the UK NICE guideline CG 103 recommends that all emergency patients aged ≥ 65 years in hospitals be examined within 48 hours.However, there are no similar guidelines in the field of surgery.In this country, the new guideline S3 on the topic "Delirium in the elderly" refers to the first issue (2).To translate known predictors of post-delirium function into pragmatic risk analyses.

Delirium can affect anyone

Delirium screening can be systematized and implemented as routine work—not just in the emergency room, but in the surgical setting, among other things.It's not just about selective attention, it's about procedural reliability.

Delirium usually develops within hours to days after surgery.It is more common in the elderly and people with long-term disabilities, but eventually it can happen to anyone.Fluctuations in attention, awareness and cognitive needs are characteristic.Some people act hyperactive during delirium, others refuse, which doesn't make it easy to diagnose.We asked experts about the topic.

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Panayi AC, Friedrich S, Rühl J, et al.: Postoperative delirium: a retrospective study of predictors, complications, and diagnostic patterns in a national surgical quality improvement program.EClinicalMedicine 2025 Nov 7;90: 103629.

Deeken F, Sánchez A, Rapp MA, et al.: Outcomes of a delirium prevention program in the elderly after elective surgery: A step-wedge randomized cluster clinical trial.JAMA Surg 2022;157 (2): e216370.

Eschweiler GW, Czornik M, Herrmann ML, et al: Risk assessment increases the risk of delirium in elective surgery for elderly patients: the PAWEL RISK study.Frontiers in Aging Neuroscience 2021;13:679933.

Recommendations for delirium and dementia screening and management of delirium in hospitals, including the German Society of Psychiatry and Psychotherapy 2023.

Mossello E, Tesi F, Di Santo SG, et al.: Recognition of delirium symptoms in clinical practice: Data from the national survey "Delirium of the Day 2015".J Am Geriatr Soc 2018;66 (2): 302-8.

De Biasi J, Reininghaus E, Schoberer D: Delirium in dementia: early detection and treatment - descriptive review [Delirium in dementia: early detection and treatment].Z Gerontol Geriatr 2023;56(7): 587-92.

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