Post-anaesthesia care unit delirium: incidence, risk factors and associated adverse outcomes

Delirium is a sudden disturbance in attention and orientation to the environment that develops over a short period of time and tends to fluctuate in severity during the course of the day.¹ The acute confusional state of delirium occurs in 50–80% of critically ill patients and postoperatively (from the day after surgery onwards) in up to 54% of elective major non-cardiac surgical patients.¹ It incurs a huge societal burden, because of, in part, a result of its association with increased morbidity and mortality; each additional day of delirium has been independently associated with a 10% increased risk of death.² Increased morbidity contributes to prolonged hospital length of stay and significant financial implications: delirium is estimated to total $4–16 billion annually.³ Its association with long-term neuropsychological and cognitive deficits^4–7 mandates a better understanding of the pathogenesis of delirium⁸ and the mechanisms underlying the prolonged disruption of cognitive processing.⁹ Despite these apparent strong associations, it remains unclear whether delirium identified in the post-anaesthetic care unit (PACU) or recovery unit is associated with similar outcomes. For anaesthetists, this is a critical question that remains unanswered. Indeed at least some of these events are of limited duration and hence it could be assumed they would be associated with less severe consequences. In this context, PACU delirium is differentiated from postoperative delirium as the latter occurs from the day after surgery onwards whereas the former occurs in the PACU on the day of surgery.

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