Postoperative delirium: which factors increase risk?

Postoperative delirium: which factors increase risk?

• A. Age >65
• B. Cognitive impairment
• C. Polypharmacy
• D. All of the above

Answer: (D)

Postoperative delirium tends to occur when the brain has preexisting vulnerabilities that can be tipped over by the stress of surgery and anesthesia. Age over 65 is a risk because aging reduces brain reserve and makes neurons more susceptible to insults from anesthesia, inflammation, and metabolic changes. Baseline cognitive impairment further lowers the brain’s ability to compensate for these disturbances, so delirium is more likely to appear after surgery. Polypharmacy adds to the risk by increasing the total sedative and anticholinergic burden and the chance of drug interactions, all of which can disrupt neurotransmitter balance and brain function in the postoperative period. Because these factors contribute independently, having all of them together markedly raises the likelihood of delirium. That’s why selecting all of the above is the best answer. In practice, recognizing these risks supports preventive steps like optimizing medications, avoiding anticholinergics and excessive sedatives, ensuring good hydration and sleep, and promoting early mobilization and delirium screening.

Postoperative delirium tends to occur when the brain has preexisting vulnerabilities that can be tipped over by the stress of surgery and anesthesia. Age over 65 is a risk because aging reduces brain reserve and makes neurons more susceptible to insults from anesthesia, inflammation, and metabolic changes. Baseline cognitive impairment further lowers the brain’s ability to compensate for these disturbances, so delirium is more likely to appear after surgery. Polypharmacy adds to the risk by increasing the total sedative and anticholinergic burden and the chance of drug interactions, all of which can disrupt neurotransmitter balance and brain function in the postoperative period. Because these factors contribute independently, having all of them together markedly raises the likelihood of delirium. That’s why selecting all of the above is the best answer. In practice, recognizing these risks supports preventive steps like optimizing medications, avoiding anticholinergics and excessive sedatives, ensuring good hydration and sleep, and promoting early mobilization and delirium screening.