Implementation of an Anesthesia Practice Change to Impact Postoperative Cognitive Dysfunction

Abstract

Problem: Approximately 25-40% of patients over the age of 60 who undergo anesthesia experience postoperative cognitive dysfunction (POCD) at hospital discharge, and 10% continue to suffer from this complication 3 months postoperatively. Devastating physical and financial outcomes occur including prolonged hospital stays, higher rates of readmission, financial stress and dependence, as well as increased mortality. Intraoperative administration of dexamethasone and dexmedetomidine are evidence-based effective strategies to reduce the incidence of POCD. Purpose: The purpose of this Quality Improvement (QI) project is to implement an anesthesia practice change to impact the incidence of POCD. The overall goal is to increase adherence to the administration of intraoperative dexamethasone and dexmedetomidine for patients who are identified preoperatively as high-risk for POCD through screening. Methods: Through collaboration with anesthesia leadership and other key stakeholders, a site-specific intraoperative checklist was developed to illustrate the anesthesia practice change. Anesthesia providers were prompted to evaluate results of the preoperative screening; patients with a positive screening result, indicating a higher risk of developing POCD, should be administered at least one of the evidence-based interventions listed on the intraoperative checklist. Administration of these interventions were documented on a paper checklist and collected for data analysis. Results: Preimplementation rates of dexamethasone and/or dexmedetomidine administration to patients aged 60 or older was compared to post-implementation rates of administration to high-risk individuals. Post-implementation findings demonstrate an overall adherence of 93.8% to the anesthesia practice change. Conclusions: Intraoperative administration of dexamethasone and/or dexmedetomidine is a safe, effective, and feasible strategy to reduce the risk of POCD in highrisk surgical patients.