ArticlePatient safety in surgery2025
High prevalence of unrecognized postoperative delirium in elderly patients: a prospective cohort study from a resource-limited country.
Article in Patient safety in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Perioperative Interventions Based on Fasting Protocols and Carbohydrate Loading in Non-Cardiac Surgery in Older Adults: A Scoping Review.Medicina (Kaunas, Lithuania) · 2026Article
- Development and internal validation of a perioperative nomogram for predicting post-operative delirium in geriatric patients with intertrochanteric fractures undergoing internal fixation with pre-operative low-dose dexamethasone.Frontiers in medicine · 2026Article
- Postoperative delirium in elderly orthopedic patients: a narrative review of prevention and multidisciplinary nursing interventions.Frontiers in psychiatry · 2026Review
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5 authors.
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Abstract
backgroundPostoperative delirium is a frequent complication following surgery in elderly patients. Despite its strong association with poor health outcomes the literature in Nigeria has been limited to a few case-reports. A major barrier to improving delirium care in elderly individuals is its poor detection, particularly in surgical populations. We aimed to determine the incidence, detection rate and risk factors for postoperative delirium in our cohort of elderly surgical patients.
methodsWe conducted a prospective cohort study in a regional orthopedic and plastic surgical center in Enugu, Southeast Nigeria, between April 2020 and March 2024. The participants were patients aged 65 years and above, who underwent surgical procedures. Each patient was visited daily by a trained nonpsychiatrist physician during the first three days after surgery and was assessed for delirium during each visit. The "Confusion Assessment Method" algorithm was used for the diagnosis of delirium. The motor subtypes were classified on the basis of the predominant psychomotor disturbance (hyperactive, hypoactive, mixed, or none). Multivariate analysis via binary logistic regression was used to determine the predictors of delirium. The level of statistical significance was determined by a p value of < 0.05.
resultsData from 304 patients (mean age, 71.7 ± 6.4 years) were analyzed. The incidence of postoperative delirium was 24.0% (73/304). The delirium subtype manifestations were "hypoactive" 35.6%, "hyperactive" 35.6%, "mixed" 20.5%, and "none" 8.2%. Approximately 92% (67/73) of the delirious cases presented within 48 h following surgery. Among the delirious cases, 90.4% (66/73) were undetected by the managing surgical teams and nursing personnel. The predictors of delirium were perioperative anaemia (AOR = 4.6; 95% CI: 1.3-16.5), impaired preoperative cognitive status; (AOR = 4.5; 95% CI: 2.0-9.9), perioperative blood transfusion (AOR = 2.1; 95% CI: 1.1-4.2), and surgery lasting between 120 and 179 min (AOR = 0.3; 95% CI: 0.1-0.8).
conclusionPostoperative delirium was grossly underrecognized by the managing surgical teams and nursing personnel. Education of the healthcare providers, with implementation of routine monitoring for postoperative delirium using validated tools is recommended. Perioperative anaemia and blood transfusion were modifiable risk factors for postoperative delirium in these patients, and improvements in patient blood management offer great potential for safer care.
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