Poster Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2026

Detection of delirium in older surgical patients with the implementation of a co-management model of care: a pre-post study (#268)

Kit Ming Foo 1 , Roger Ho 1 , Tanita Botha 2 3 , Stephanie Than 1 4
  1. Department of Geriatric Medicine, Western Health, Melbourne, Victoria, Australia
  2. Office of Research, Western Health, Melbourne, Victoria, Australia
  3. Biostatistics Unit - Faculty of Health, Deakin University, Geelong, Victoria, Australia
  4. Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia

Aims

The number of older people undergoing surgery is increasing, and this amplifies the risk of perioperative delirium and associated adverse outcomes. We compared the incidence of delirium before and after the implementation of a perioperative co-management service (Peri-Operative Endocrine and Medical Services [POEMS]) in older people who underwent vascular or urological surgery. The POEMS team was comprised of general physicians, endocrinologists and geriatricians.

 

Methods

A retrospective, non-randomised pre-post study using Electronic Medical Record (EMR) data was conducted at a large tertiary hospital in Melbourne, Australia. We included all vascular surgery or urology patients aged >65 years who received general anaesthesia during surgery. Five months of data pre- and post- the POEMS intervention was examined. We measured delirium cases using ICD-10 codes and EMR, and screened EMR for surrogate markers of delirium in people without a formal diagnosis (4AT score >=4 and key words1). Secondary outcomes included discharge disposition, length of stay and mortality.

 

Results

A total of 244 individuals were included (122 pre-POEMS, 122 post-POEMS). Mean age was similar between groups (75 years). The post-POEMS group had more delirium diagnoses recorded than the pre-POEMS group (11.5% vs 6.6%, p=0.26). One in 5 patients had a possible undiagnosed delirium, but there was no between-group difference (p=0.83). The post-POEMS group had longer mean length of stay and more discharges to subacute wards.

 

Conclusion

It is possible that the POEMS model of care in older surgical patients results in slightly better detection of delirium, but the overall capture rate remains poor.

 

  1. 1. Puelle MR, Kosar CM, Xu G, et al. The Language of Delirium: Keywords for Identifying Delirium from Medical Records. J Gerontol Nurs. 2015;41(8):34-42. doi:10.3928/00989134-20150723-01