July 1, 2026 Salus Health Care Forum

I think as a mental health professional, it would have been so great if that was part of the curriculum in terms of screening, how do you screen for this, what are the questions you should be asking on the front end. Whenever I get somebody in my clinic, it never occurred to me to say, have you had recent surgery? It was not on my radar until last year. And so I’m making the assumption, obviously, that there may be many of us out there still treating people that don’t even think about that factor and what’s happening to them neurologically. So I thought it was a good discussion for us to have because we have this forum, because we can talk from different disciplines, what we can do better for our patient load to help them manage even going into surgery, how can they be more healthy, how can they manage their body and be more ready for that type of invasion. I see it as an invasion, I know it’s a necessary evil, obviously, but from somebody who really tries to stay away from having any sort of medicinal, if possible, it left me feeling really saddened that I hadn’t really paid that much attention to it in my own career, and wondering how many people have after effect that don’t know to attribute it to anesthesia. Mark, did you want to say some more about that?

Mark

This is a broad topic and from our discussion, it’s the physician you spoke with, correct me if I’m wrong, said like 70%.

Gay

Yeah, it was a huge exaggeration.

Mark

Well, it’s anesthesia is going to stay closer to 20%. It’s a moot point on whether it’s 20 or 70, it does exist and it is associated very strongly with the number one, just your co-morbidities going into surgery. And in particular, dependency on activities of daily living, it’s estimated that as much as 20% of the US population is defined as frail. There’s a dozen different metrics on what frailty is. The best one is a proxy on that, because some are very extensive and very impractical, but the best one is to really drill down if there’s been a change in your ADLs and how much support you need.

So that’s number one. Other factors are if you’ve had congestive heart failure in the last 30 days, if you’re a diabetic, if you have COPD and you’re currently treated with the antibiotics, hypertensives, uncontrolled, and previous anesthetics where you experienced delirium. And that’s what I drill down to because the other ones are hopefully covered by primary care physicians already.

But it’s felt that 20 to 50% of the greater than 65 age group experience some kind of postoperative delirium. And it could easily  be broadly divided into hyperactive and hypoactive. The hyperactive are easy to diagnose. They’re the people that wake up crazy, agitated. The way underdiagnosed are those who are in a recovery room. These patient looks comfortable, but internally, they’re totally disoriented. They’re quiet but disoriented. Those are the ones that are really worrisome. And then there’s about a third that are mixed. As far as risk factors, it seems like the depth of anesthesia is very important. The current bispectral monitors are expensive.

They’re not accurate. They’re affected more by certain anesthetics than others. It really comes down to one of the major risk factors. What type of surgery is being done. In order of increasing risk are abdominal surgery, anything in the main body cavity, then cardiothoracic.