Hospital Variation in Postoperative Delirium Screening and Outcomes in Older Adult Surgical Patients: A National Analysis of Geriatric and Non-Geriatric Surgery Verification Hospitals

BACKGROUND: Postoperative delirium in older surgical patients drives morbidity, mortality, and resource utilization, yet real-world implementation and impact of standardized screening within older adult-focused surgical programs remain undefined. STUDY DESIGN: Retrospective cohort study of ACS NSQIP (January-December 2024) including inpatients aged ≥75 years. Primary endpoints were postoperative delirium screening and screen positivity. Outcomes were compared between American College of Surgeons Geriatric Surgery Verification (GSV) and non-GSV hospitals, with stratification by hospital-level screening frequency. Secondary endpoints included length of stay (LOS), prolonged LOS (top quartile), and 30-day readmissions. RESULTS: Among 97,886 patients (mean age 81.7±5.3 years), 53.0% underwent delirium screening. Screening was higher at GSV hospitals (94.3% vs. 52.5%). Overall delirium screen positivity was 12.5% and did not differ between GSV and non-GSV hospitals (11.3% vs. 12.5%, p=0.25), with similar delirium risk per 100 patient-days. Among screened patients, GSV hospitals demonstrated shorter LOS and fewer prolonged LOS. Among patients with positive delirium screens, LOS, prolonged LOS, and 30-day readmissions were similar across hospital types. CONCLUSIONS: GSV hospitals achieve substantially higher delirium screening without increased detection rates, suggesting observed variation reflects screening practices rather than true incidence. Shorter LOS among screened patients at GSV hospitals indicates that structured geriatric perioperative care processes may improve efficiency and outcomes independent of delirium occurrence, whereas outcomes converge once delirium develops.