Perioperative delirium in older adult patients undergoing colectomy: Are we screening enough?

BACKGROUND

Postoperative delirium is a common complication among older adults undergoing surgery and is associated with increased morbidity, mortality, and healthcare utilization. Although routine screening is recommended for patients at a high risk, screening practices after colectomy remain poorly characterized.

METHODS

We performed a retrospective cohort study using 2024 American College of Surgeons National Surgical Quality Improvement Program data. Adults aged 75 years and older who were undergoing inpatient colectomy were included. Primary outcomes were postoperative delirium screening and positive screening results. Multivariable logistic regression was used to identify factors associated with screening and positive screening results. Secondary outcomes included hospital length of stay and 30-day readmission.

RESULTS

Of 13,729 patients, 8153 (59.3%) underwent postoperative delirium screening. Of the screened patients, 986 (12.1%) had a positive screening result. Factors independently associated with screening included a higher American Society of Anesthesiologists class, emergent surgery, a history of falls, and dementia. Among the screened patients, factors associated with positive screening results included American Society of Anesthesiologists class IV and V, underweight body mass index, preoperative sepsis, a history of falls, dementia, and open operations. Patients with positive screening results had a significantly longer length of stay. Hospital-level variation in screening was substantial, and 30.5% of hospitals screened fewer than 25% of their eligible patients.

CONCLUSION

Postoperative delirium screening occurred in only 59.3% of older adults undergoing colectomy and varied widely across hospitals. Among screened patients, more than 1 of 10 had a positive screening result, which was associated with a longer hospital stay. Standardized screening may improve detection in this high-risk population.