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• W3204366400 abstract "Dear Editor Postoperative delirium (POD) is a serious complication which is often under-recognized and it can lead to increase in length of hospital stay and poor outcomes [1]. Occurrence of POD is characterized by fluctuating changes of cognitive capacity, altered perception with hallucination, acute decline in cognition and inappropriate behavior. Early identification of patients at risk of developing delirium is important because adequate and well-timed interventions prevent occurrence of delirium and its related detrimental outcomes. Bramley et al. [2] performed an umbrella review of systematic reviews to investigate the risk factors for POD after surgery. They found that increasing age, nursing home residency, pre-existing cognitive impairment, psychiatric disorders, cerebrovascular disease, end stage renal failure, low albumin, high American Society of Anesthesiologists (ASA) score, and intra-operative blood transfusion were risk factors for POD. The pathophysiology of delirium is still poorly understood. In spite of many studies to find a common mechanism that explains all aspects of delirium, there is not a single mechanism which has been identified that can explain the whole syndrome with its heterogeneous etiologies and presentations. There are two leading hypotheses that may help us to better understand the complex nature of delirium [3]. The first emphasizes on the role of inflammation, particularly the action of cytokines on blood-brain barrier and the impact of chronic stress on cytokine and cortisol levels. The second highlights the neurochemical imbalances that affect neurotransmission. While more effort is needed to reduce incidence of POD, a multidisciplinary team should be trained and formed to recognize early signs of POD. The recently published European Society of Anaesthesiology-guideline on prevention of POD proposes to screen for POD starting in the recovery room, and in each shift up to 5 days postoperatively [4]. In addition to screening with standardized assessment tools, providing information about clinical symptoms to all team members can help in diagnosing the often fluctuating course of the syndrome. Training of staff members involved in postoperative treatment and standardization of screening increase detection rates and help to avoid delays in treatments. When POD occurs, differential diagnostics and search for overlooked precipitating factors are warranted. Symptomatic treatment of POD should be based on careful titration of neuroleptics such as haloperidole or atypical neuroleptics. Finally, the relatively small number of patients with delirium involved in the present study does not permit strong conclusions to be drawn, A prediction model for delirium in elderly undergoing major elective surgery should be developed using large series, with attention to validation and updating of the existing prediction models. Provenance and peer review Commentary, internally reviewed Ethical approval Ethical approval is not required. Sources of funding None. Author contribution Bo Ma: writing; Zhicong Ma: study design. Research registration unique identifying number (UIN) None. If you are submitting an RCT, please state the trial registry number – ISRCTN This is not an RCT. Guarantor Zhicong Ma. Disclosure The following additional information is required for submission. Please note that failure to respond to these questions/statements will mean your submission will be returned. If you have nothing to declare in any of these categories then this should be stated. Declaration of competing interest All author states that there is no conflicts of interest." @default.
• W3204366400 created "2021-10-11" @default.
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• W3204366400 date "2021-10-01" @default.
• W3204366400 modified "2023-09-23" @default.
• W3204366400 title "A commentary on “Risk factors for postoperative delirium: An umbrella review of systematic reviews” (Int J Surg 2021 Aug; 93: 106063)" @default.
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• W3204366400 doi "https://doi.org/10.1016/j.ijsu.2021.106131" @default.
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