To evaluate the evidentiary foundation of the ACS Perioperative Protocol for older adults aged ≥65.
Conducted a scoping review per PRISMA-ScR.
Searched MEDLINE from inception to September 2024 for studies on surgical populations aged ≥65.
Narratively synthesized evidence and characterized certainty using GRADE.
67 studies included; multicomponent delirium prevention reduced incidence of postoperative delirium by 33.2%, with relevant reductions in vascular populations.
Routine delirium screening identified under-recognized cases with 93% sensitivity.
Fall prevention showed robust evidence; structured programs avoided $14,600 per 1,000 patient-days.