Awareness and Perspectives among Asian Anesthesiologists on Postoperative Delirium: A Multinational Survey.

Hyungmook Lee,Varinee Lekprasert,Edwin Seet,Sophia Tsong Huey Chew,Ki-Young Lee,Jeongmin Kim,Prok Laosuwan,Tong J Gan,Lian Kah Ti,Vera Lim

doi:10.3390/jcm10245769

Abstract

Postoperative delirium (POD) is a common perioperative complication. Although POD is preventable in up to 40% of patients, it is frequently overlooked. The objective of the survey is to determine the level of knowledge and clinical practices related to POD among anesthesiologists in different Asian countries. A questionnaire of 22 questions was designed by members of the Asian focus group for the study of POD, and it was sent to anesthesiologists in Singapore, Thailand, and South Korea from 1 April 2019 through 17 September 2019. In total, 531 anesthesiologists (Singapore: 224, Thailand: 124, Korea: 183) responded to the survey. Half the respondents estimated the incidence of POD to be 11–30% and believed that it typically occurs in the first 48 h after surgery. Among eight important postoperative complications, POD was ranked fifth. While 51.4% did not perform any test for POD, only 13.7% monitored the depth of anesthesia in all their patients. However, 83.8% preferred depth of anesthesia monitoring if they underwent surgery themselves. The results suggest that Asian anesthesiologists underestimate the incidence and relevance of POD. Because it increases perioperative mortality and morbidity, there is an urgent need to educate anesthesiologists regarding the recognition, prevention, detection, and management of POD.

Highlights

Of late, concerns regarding the association between surgery and/or anesthesia and perioperative neurocognitive disorder (NCD), including postoperative delirium (POD), have been increasing
The Postoperative delirium (POD) focus group members distributed the survey in SG, TH, and K from 1
For elderly patients undergoing non-cardiac surgery, the frequency of POD occurrence was estimated as less than 10% by 18.3% respondents, 11% to 30% by 51.4% respondents, 31% to 50% by 22.0% respondents, and more than 50% by 8.3% respondents

Summary

Introduction

Concerns regarding the association between surgery and/or anesthesia and perioperative neurocognitive disorder (NCD), including postoperative delirium (POD), have been increasing. Several factors such as repeated exposure to surgery and/or anesthesia, hypothermia during surgery, excessive neuroinflammation, and an excessive depth of anesthesia are associated with POD [1]. Acute neurocognitive decline after surgery is termed POD, which is associated with significant postoperative morbidity and mortality. POD is a common perioperative complication, with the reported incidence being as low as 1.4% in an ambulatory setting and as high as 60% in patients undergoing emergency major vascular surgeries [5,6]. POD is preventable in up to 40% of patients [10]

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Results

Conclusion