post-op delirium. You can use that information to bolster their health
before surgery and ensure post-op actions (like reorientation and mobi-
lization) are prioritized to prevent delirium. Let's take a quick look at
these screening tools.
• NSQIP risk calculator. This free online tool estimates a patient's
risk of suffering surgical complications based on several baseline vari-
ables, including age, sex, BMI, physical function and comorbidities
(riskcalculator.facs.org). The calculator combines a patient's base-
line risk with the anticipated physical insult of specific surgeries, and
calculates an overall risk percentage score for serious complications.
Patients with NSQIP risk scores of 21% or greater are at risk of experi-
encing moderate to severe delirium, with higher numbers associated
with more severe forms of the condition.
• TMT Part B. There's a proven association between pre-op execu-
tive function — a measure of attention level and problem-solving abil-
ities — and incidence of post-op delirium. This test, which measures
executive function, consists of 25 circles containing numbers (1 to 13)
and letters (A to L). Patients must draw a line connecting the circles
in ascending order, alternating between numbers and letters. (1-A-2-B-
3-C and so on). The longer it takes patients to complete the test, the
worse their executive function; an average score is 75 seconds and a
deficient score is longer than 273 seconds. The screening tool is avail-
able as an easy-to-administer iPad app (osmag.net/QKJwG7).
The higher the scores of the 2 tests, the higher the risk of the
patient experiencing severe delirium after surgery. Using the tests
in combination is not a perfect predictor of how severe post-op
delirium will be, but it's an improvement over current screening
methods, which focus on older adults with dementia-level cognitive
impairment. Those patients are indeed at the highest risk of suffer-
ing severe post-op delirium, but focusing on those individuals
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