Robinson et al identified risk factors for postoperative delirium in an alderly patient undergoing major surgery. These can help to identify a patient who may benefit from more aggressive management.The authors are from University of Colorado at Denver and the Denver VA Medical Center.


Patient selection: patient >= 50 years undergoing major surgery


Preoperative risk factors:

(1) increasing age (postoperative delirium in 20% for 50-59 years to 90% if >= 80 years)

(2) serum albumin < 3.4 g/dL

(3) anemia

(4) functional disability

(5) pre-existing dementia or cognitive impairment

(6) comorbidity (using the Charlson index)

(7) history of alcohol abuse


Intraoperative risk factors:

(1) intraoperative hypotension with systolic blood pressure < 90 mm Hg

(2) blood transfusion (>= 3 units)


Limitations: Postoperative risk factors were not reported. These may include:

(1) drug or alcohol withdrawal

(2) opiate therapy


The occurrence of postoperative delirium was associated with worse outcomes including length of hospital stay, postdischarge institutionalization and mortality at 6 months.


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