From the Department of Anesthesiology, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Anesth Analg. 2020 Jun;130(6):1572-1590. doi: 10.1213/ANE.0000000000004641.
Postoperative delirium is a geriatric syndrome that manifests as changes in cognition, attention, and levels of consciousness after surgery. It occurs in up to 50% of patients after major surgery and is associated with adverse outcomes, including increased hospital length of stay, higher cost of care, higher rates of institutionalization after discharge, and higher rates of readmission. Furthermore, it is associated with functional decline and cognitive impairments after surgery. As the age and medical complexity of our surgical population increases, practitioners need the skills to identify and prevent delirium in this high-risk population. Because delirium is a common and consequential postoperative complication, there has been an abundance of recent research focused on delirium, conducted by clinicians from a variety of specialties. There have also been several reviews and recommendation statements; however, these have not been based on robust evidence. The Sixth Perioperative Quality Initiative (POQI-6) consensus conference brought together a team of multidisciplinary experts to formally survey and evaluate the literature on postoperative delirium prevention and provide evidence-based recommendations using an iterative Delphi process and Grading of Recommendations Assessment, Development and Evaluation (GRADE) Criteria for evaluating biomedical literature.
术后谵妄是一种老年综合征，表现为手术后认知、注意力和意识水平的变化。它发生在高达 50%的大手术后患者中，并与不良后果相关，包括住院时间延长、护理费用增加、出院后住院率增加和再入院率增加。此外，它与手术后的功能下降和认知障碍有关。随着我们手术人群的年龄和医疗复杂性的增加，临床医生需要有识别和预防高危人群谵妄的技能。由于谵妄是一种常见且后果严重的术后并发症，因此最近有大量针对谵妄的临床研究，这些研究来自于不同专业的临床医生。也有一些综述和推荐声明，但这些都不是基于强有力的证据。第六次围手术期质量倡议（POQI-6）共识会议召集了一组多学科专家，使用迭代 Delphi 过程和评估生物医学文献的分级推荐评估、制定和评价（GRADE）标准，正式调查和评估术后谵妄预防的文献，并提供基于证据的建议。
