UNDERSTANDING POSTOPERATIVE DELIRIUM AND RISK FACTORS IN ELDERLY PATIENTS: A NARRATIVE REVIEW

Abstract

This article sought to relate delirium, a disorder characterized by changes affecting consciousness, cognition, and attention, and its high incidence in geriatric patients, with a focus on postoperative delirium (POD). Thus, the objective of this study was to critically analyze recent scientific literature to provide pre-, intra-, and postoperative contributing factors for the development of POD. The methodology used encompasses a narrative review study of the existing literature between 2019-2024, in the VHL (Virtual Health Library) and PubMed databases, addressing peri- and postoperative effects on delirium incidence in the elderly. After applying the exclusion criteria, 5 of the 21 studies were analyzed. Regarding the results, it became evident that there are preoperative factors contributing to POD, such as: frailty, advanced age, previous cognitive and functional decline, simultaneous comorbidities, polypharmacy, inadequate pain control, anemia, renal failure, low serum albumin levels, electrolyte imbalance, infection, and the use of opioids, fentanyl, and haloperidol. In addition, other predisposing factors are: male sex, smoking, hypertension (HAS), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), acute myocardial infarction (AMI), the need for extracorporeal circulation, and longer hospitalization time. Protective factors include daily awakening and the use of DEX (dexmedetomidine) associated with sufentanil. Finally, hospitalization time was longer in patients with delirium, and the drug DEX decreases its incidence. It is concluded, therefore, the complexity involved in the management of POD, requiring special attention to the elderly due to the presence of other comorbidities. The identification of only two protective factors shows the need for more studies focused on the prevention of delirium. There was contradiction in the prevalence of delirium types, which highlights the importance of individualized evaluations. Thus, the absence of a broad literature focusing on the elderly reflects the importance of new studies with the geriatric population.