Trial Outcomes & Findings for Mitigation of Postoperative Delirium in High-Risk Patients (NCT NCT05777187)

Mitigation of Postoperative Delirium in High-Risk Patients

Postoperative Delirium measured using the 4 A's Test (4AT) delirium assessment documentation. The 4AT is a commonly used tool that identifies the presence/absence of Postoperative Delirium (POD). It consists of 4 sections; alertness, AMT4: Abbreviated Mental Test -4, attention, and acute change of fluctuating course. The 4AT is scored from 0-12, with higher score indicating poorer health outcomes. Scoring: 4 or above: possible delirium +/- cognitive impairment 1-3: possible cognitive impairment 0: delirium or severe cognitive impairment unlikely (but delirium still possible if \[4\] information incomplete)

Adherence will be measured as a binary variable; overall protocol adherence will be defined as the number of participants where best practices was performed by the anesthesia team. The 12 perioperative best practices are grouped in 5 intervention domains including, avoid potential inappropriate medication, perioperative glycemic control, avoid hypotension, maintain normothermia, and titrate anesthetic depth. Three of 5 intervention domains measured by number of participants where the following conditions met: Within avoid potential inappropriate medication is avoid diphenhydramine, scopolamine, and midazolam. Within perioperative glycemic control is check pre-op glucose, check glucose every 2 hours, maintain glucose \<200 mg/dL, and check post-anesthesia care unit glucose. Within maintain normothermia is use temperature probe and maintain temperature \>36 degrees Celsius.

Avoiding hypotension is one of the 12 perioperative best practices are grouped in 5 intervention domains including, avoid potential inappropriate medication, perioperative glycemic control, avoid hypotension, maintain normothermia, and titrate anesthetic depth. Within avoid hypotension is Mean Arterial Pressure (MAP) \>65 mmHg. MAP assess blood flow throughout the body.

Age-adjusted Minimum Alveolar Concentration (MAC) represents the concentration of anesthetic gas required to prevent movement in response to surgical stimuli, adjusted for a patient's age. For every case, age-adjusted MAC values were calculated for each minute during anesthetic administration using standard formulas. The calculation was performed as follows: For every case and for every minute that anesthetic gas was administered to a person, the age-adjusted MAC was calculated using the formula. For each minute, compute the sum of all age adjusted MAC values for all gases administered Next, % MAC was calculated for every case as TOTAL # of mins where MAC\>1 /# of minutes X 100 MAC\>1 indicates that it is more anesthetic than is typical for a patient with given demographics is being administered.