Postoperative delirium (POD) is a common and serious neuropsychiatric complication following orthopedic surgeries, particularly in elderly patients. This integrative review aimed to provide a comprehensive synthesis of the current literature on the risk factors, pathophysiological mechanisms, prevention strategies, and management approaches for POD in orthopedic patients. The review identified a multitude of risk factors contributing to the development of POD, encompassing patient-related factors, preoperative factors, intraoperative factors, and postoperative factors The pathophysiology of POD is complex and involves an interplay of neurotransmitter imbalances, neuroinflammation, and oxidative stress. Prevention of POD requires a multimodal approach, incorporating both pharmacological interventions and non-pharmacological strategies. The management of POD necessitates a multidisciplinary approach, combining targeted pharmacotherapy with non-pharmacological interventions to control symptoms and promote recovery. Despite significant advancements in understanding POD, there remain gaps in knowledge that warrant further investigation. In conclusion, this review underscores the importance of implementing evidence-based, multicomponent interventions that integrate pharmacological and non-pharmacological strategies to reduce the incidence and severity of POD in orthopedic patients. Continued research efforts and dissemination of best practices are essential to mitigate the impact of this debilitating complication and improve patient outcomes.
Huang et al. (2025) studied this question.