Delirium after surgery: prehabilitation, quality of life and risk factors in older patients

Abstract

The ageing of the world’s population requires new methods to prevent adverse outcomes such as delirium in older patients after surgery. Delirium is an expression of depleted reserves, which in turn decreases a patient’s resilience and makes a patient more frail. It may be triggered due to precipitating risk factors that shift the balance and overflow a patient’s resilience. A systematic review and meta-analysis demonstrated that delirium can be prevented by implementing multicomponent interventions. Therefore, a new multicomponent prehabilitation intervention was designed. The incidence of delirium was successfully reduced by implementing this prehabilitation program, however no effects were seen on all other short-term outcomes. On the long term, postoperative delirium increases the risk of 1-year mortality over 4 times and is associated with decreased functional outcomes after 6 and 12 months. Moreover, surgery and subsequent delirium affect the quality of life of patients and caregivers and may lead to depressive symptoms. Faster return to preoperative functioning may therefore be key to a faster return to preoperative quality of life. Future perioperative care pathways focusing on delirium prevention, optimisation and fast return to baseline functioning after surgery, should begin prior to hospital admission and end long after discharge.