Preparing for surgery is stressful enough, with all the potential complications associated with a fix of whatever’s wrong. But add to the mix, the possibility of postoperative delirium and it’s downright scary. For reasons we don’t quite know, this condition is most associated with joint replacement and heart surgery, particularly in the elderly.
Postoperative delirium occurs in 1% to 61% of patients following anesthesia. It’s characterized by confusion, disorientation, fluctuating levels of consciousness, altered psychomotor activity, and disturbed sleep-wake cycles. These symptoms usually occur on the first or second day after surgery and worsen at night. Underlying dementia can complicate the situation, as symptoms are often confused by the treatment team. This happened to a client of ours with early stage Alzheimer’s disease. He underwent joint replacement surgery and woke from anesthesia experiencing hallucinations and agitation so severe he required restraints. In the following weeks, he slipped into critical confusion and depression. Fortunately, with aggressive advocacy on our part, his symptoms of dementia were distinguished from the delirium and he is now on the mend.
Age, dementia drugs, and certain metabolic diseases increase the risk of postoperative delirium. Approximately 30% of cases are related to drug toxicity, an often preventable risk factor. Before surgery, disclose all medical conditions and drugs and ask the anesthesiologist about your risks. While it’s impossible to prevent postoperative delirium in all surgeries, being prepared will help you and your family pave the way for your best recovery.