Postoperative delirium: etiology and management.

PURPOSE OF REVIEW: Postoperative delirium is a pervasive and complicated process that poses numerous challenges for the perioperative physician and entails significant consequences for the patient.

RECENT FINDINGS: Postoperative delirium affects on average 36.8% of surgical patients, ranging from 9 to 87% depending on age, setting, type of surgery and other risk factors. This number may in fact be an underestimation based on the variation in screening practices. Meta-analyses show that in a mix of medical and surgical patients, a single episode of delirium resulted in a doubling of the odds ratio for death as well as an increase in the risk of admission to an institution and increase in dementia. It is also associated with an increase in length of mechanical ventilation in addition to total length of ICU and hospital length of stay.

SUMMARY: All told, the cost of delirium in the United States alone is estimated to be between US$ 38 and 152 billion. Thus, it is no surprise that there is considerable interest in understanding and treating the problem.