Outpatient Surgery Magazine

7 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 9 W e've all seen patients with post-op delirium. They're disoriented and confused immediately after surgery. They have trouble focus- ing and are unable to participate in their care as they're either rest- less and agitated or too drowsy to pay attention. The visible short- term effects of delirium may fade fairly quickly, but research now shows that the risk of mortality increases for several years fol- lowing an episode. Patients who experience delirium are also at increased risk of falls and long- lasting cognitive decline, includ- ing dementia. Once home, the hidden symptoms of delirium may make it difficult for the patient to manage their medica- tions and care for their wounds, impeding a suc- cessful recovery. About half of your patients who are 65 years or older will experience some level of delirium after sur- gery. The bad news? There are no medications that prevent or shorten delirium. The good news? The American College of Surgeons' National Surgical Quality Improvement Program's (NSQIP) online risk calculator and the Trail Making Test Part B (TMT Part B) are easy tools that help identify patients most at risk for post-op delirium. You can use that infor- mation 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 com- plications based on several baseline variables, including age, sex, BMI, physical function and comorbidities (riskcalculator.facs.org). The calcu- lator combines a patient's baseline risk with the anticipated physical insult of specific surgeries, and calculates an overall risk percentage score for seri- ous complications. Patients with NSQIP risk scores of 21% or greater are at risk of experiencing moder- ate to severe delirium, with higher numbers associ- ated with more severe forms of the condition. • TMT Part B. There's a proven association between pre-op executive function — a measure of attention level and problem-solving abilities — 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 execu- tive function; an average score is 75 seconds and a deficient score is longer than 273 seconds. The screening tool is available as an easy-to-administer iPad app (osmag.net/QKJwG7). The higher the scores of the 2 tests, the higher Predicting Post-op Delirium Severity New ways of using old screening tools can help you identify at-risk patients. Anesthesia Alert Heidi Lindroth, PhD, RN • COMFORT MEASURES Efforts to reorient patients as soon as possible after surgery help to lessen the negative impact delirium can have on successful recoveries.

• Cover