Postoperative delirium: A comprehensive review
Year: 2026
Type: article
Abstract: Postoperative delirium (POD) is a common acute neuropsychiatric complication following surgery, especially in older patients. Characterized by fluctuating disturbances in attention, awareness, and cognition, POD typically occurs within days after surgery and can last days to weeks. Its pathophysiology involves neuroinflammation, neurotransmitter imbalances, blood–brain barrier disruption, and oxidative stress. Key risk factors include advanced age, baseline cognitive impairment, comorbidities, surgical complexity, environmental factors, and excessive deep anesthesia. Incidence varies by surgical type, with the highest rates in cardiac surgery (~23%) and hip fracture repair (30%–50%). Prevention strategies encompass nonpharmacological approaches (early mobilization, reorientation, sleep promotion) and pharmacological interventions (optimized anesthesia, dexmedetomidine, and melatonin). For established delirium, management focuses on treating underlying causes, supportive care, and the judicious use of antipsychotics for severe agitation. Beyond its immediate impact, POD is associated with concerning long-term outcomes: accelerated cognitive decline, increased dementia risk, functional deterioration, and higher mortality. Studies show that patients who experience POD have a 40% faster rate of cognitive decline and approximately double the mortality risk within 1 year compared with nondelirious patients. This relationship with adverse outcomes underscores that POD is not a transient phenomenon; rather, it may be a pivotal event in a patient’s long-term health trajectory. Implementation of evidence-based prevention and management protocols is essential to improve perioperative outcomes in our aging surgical population.
Source: Formosan Journal of Surgery
Institutions: Chang Gung University, Kaohsiung Chang Gung Memorial Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7162127490