Reducing Post-Operative Delirium and Cognitive Dysfunction: Intraoperative Anesthesia Interventions Guideline

Abstract

Problem: Post-operative delirium, a common complication in the elderly after surgery, is associated with poor outcomes such as post-operative cognitive dysfunction which is a reduction in cognitive performance following surgery that lasts months after surgery or longer. Implementation of anesthetic interventions can reduce the development of cognitive dysfunction, estimated 40 percent of post-operative delirium cases are preventable using these interventions. Purpose: The purpose of this quality improvement project was to implement and evaluate tailored anesthesia interventions for surgical patients who screened preoperatively as high risk of developing post-operative delirium/post-operative cognitive dysfunction. Methods: The project involved patients ≥ 65 years old undergoing surgery at a suburban hospital that screen as high-risk for cognitive dysfunction. Anesthesia providers were educated and demonstrated understanding of the intraoperative anesthesia interventions guideline. Anesthesia providers considered, and when clinically appropriate, provided the interventions in accordance with the guidelines and documented as customary in the patient record. Data regarding the provider’s adherence to the guidelines were collected weekly by retrospective chart review. Results: Of the eligible 345 patients, 217 underwent a cognition screening pre-operatively and 50 screened positive. Anesthesia providers gave consideration to the intraoperative guidelines an average of 96 percent during the project with a range of 50 to 100. On average, the intraoperative guidelines were adhered to 85 percent of the time with a range of 43 to 100. Conclusions: While the recommended intraoperative care was evidence based and often received consideration, execution of those cares occurred less often. This may have been an oversight on anesthesia providers or due to the contextual nature of intraoperative anesthesia care wherein the recommended guidelines were appropriate in one clinical situation but not another.