Patient Safety Priorities

  • #1 Culture of Safety, Teamwork and Clinician Safety
  • #2 Clinical Deterioration
  • #3 Non-Operating Room Anesthesia
  • #4 Perioperative Brain Health
  • #5 Opioid-Related Harm
  • #6 Medication Safety
  • #7 Infectious Diseases
  • #8 Airway Management
    • APSF Patient Safety Priorities > #4 Perioperative Brain Health

    Perioperative Brain Health

    Perioperative delirium, cognitive dysfunction, and brain health
    Chair(s): Ryan Field, MD; Jeffrey Huang, MD
    Click here to see all group members.
    Table of Contents

    Overview

    Cognitive dysfunction after anesthesia and surgery has been documented for over 100 years. Post-operative cognitive dysfunction (POCD), which refers to cognitive decline following anesthesia and surgery, is becoming a significant concern as the population ages.1 POCD typically involves reduced attention, slower information processing, and memory problems, often along with mood and personality changes. Up to 53% of older adults show cognitive impairment at hospital discharge. While many recover, some experience persistent or worsening symptoms, with 10-33% affected at 3-6 months post-surgery and 33-42% at 1-5 years.2-6

    Postoperative delirium, presenting as confusion and inattention within a week after surgery, is the most common complication in older adults, occurring in up to 65% of cases. This condition significantly raises healthcare costs, estimated at $32.9 billion annually.7

    Enhancing brain health during the perioperative period is essential. Anesthesia professionals are uniquely positioned to identify patients at risk for perioperative neurocognitive disorders and to implement strategies that help prevent these complications.

    REFERENCES

    1. Le Y, Liu S, Peng M, Tan C, Liao Q, Duan K, Ouyang W, Tong J. Aging differentially affects the loss of neuronal dendritic spine, neuroinflammation and memory impairment at rats after surgery. PLoS One. 2014;9(9):e106837.
    2. Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, Mark DB, Reves JG, Blumenthal JA, Neurological Outcome Research G, the Cardiothoracic Anesthesiology Research Endeavors I. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344(6):395-402.
    3. Franck M, Nerlich K, Neuner B, Schlattmann P, Brockhaus WR, Spies CD, Radtke FM. No convincing association between post-operative delirium and post-operative cognitive dysfunction: a secondary analysis. Acta Anaesthesiol Scand. 2016;60(10):1404-14.
    4. Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, Rabbitt P, Jolles J, Larsen K, Hanning CD, Langeron O, Johnson T, Lauven PM, Kristensen PA, Biedler A, van Beem H, Fraidakis O, Silverstein JH, Beneken JE, Gravenstein JS. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998;351(9106):857-61.
    5. Relander K, Hietanen M, Nuotio K, Ijas P, Tikkala I, Saimanen E, Lindsberg PJ, Soinne L. Cognitive dysfunction and mortality After carotid endarterectomy. Front Neurol. 2020;11:593719. Epub 20210114.
    6. Van Dijk D, Jansen EW, Hijman R, Nierich AP, Diephuis JC, Moons KG, Lahpor JR, Borst C, Keizer AM, Nathoe HM, Grobbee DE, De Jaegere PP, Kalkman CJ, Octopus Study G. Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial. JAMA. 2002;287(11):1405-12.
    7. Gou RY, Hshieh TT, Marcantonio ER, et al. One-year medicare costs associated with delirium in older patients undergoing major elective surgery. JAMA Surg.2021;156:430–442.

     

    Articles

    Perioperative Brain Health and Postoperative Delirium Prevention: Recommendations from the APSF Brain Health Patient Safety Priority Advisory GroupPerioperative Brain Health and Postoperative Delirium Prevention: Recommendations from the APSF Brain Health Patient Safety Priority Advisory Group
    Ryan Field, MD; Lisa Bethea, MD; Arney Abcejo, MD; Jeffrey Huang, MD
    APSF Newsletter, October 2025
    Perioperative Brain HealthPerioperative Brain Health: A Patient Safety Priority All Anesthesia Professionals Must Address
    Natalie C. Moreland, MD; Lena Scotto, MD; Arnoley S Abcejo, MD; Emily Methangkool, MD, MPH
    APSF Newsletter, June 2023
    InfantThe Effect of General Anesthesia on the Developing Brain: Is it Time to Temper the Concern?
    Luke S. Janik, MD
    APSF Newsletter, October 2020
    Pathophysiological hypotheses of PostOperative Delirium. NeuroTR: Neurotransmitter.Brain Safety: The Next Frontier for Our Specialty?
    Nirav Kamdar, MD, MPP, MBA; Phillip E. Vlisides, MD; Daniel J. Cole, MD
    APSF Newsletter, October 2020
    Old WomanPerioperative Brain Health—It’s Not All Positive Attitude, Exercise, and Superfoods
    Nirav Kamdar, MD, MPP; Lee A. Fleisher, MD; Daniel Cole, MD
    APSF Newsletter, February 2019
    ConcussionIs a Concussed Brain a Vulnerable Brain? Anesthesia after Concussion
    Arnoley S. Abcejo, MD; Jeffrey J. Pasternak, MD
    APSF Newsletter, October 2018

     

    Resources

    APSF COLLABORATIONS

    The APSF Brain Health Advisory Group has officially established collaborations with the ASA Committee on Geriatric Anesthesia and the ASA Perioperative Brain Health Initiative to advance research and implementation in perioperative brain health.

    In addition, the group has partnered with the Society for the Advancement of Geriatric Anesthesia (SAGA) to further promote research, education, and clinical implementation in this important area.

    APSF PODCASTS

     

    APSF Activities

    APSF GRANTS & AWARDS

    APSF has supported multiple grants and awards on perioperative brain health.

    Elizabeth Mahanna-Gabrielli, MD

    Elizabeth Mahanna-Gabrielli, MD

    2025
    Elizabeth Mahanna-Gabrielli, MD
    Associate Professor, Anesthesiology, Perioperative Medicine, and Pain Management
    Miller School of Medicine, University of Miami
    Grant Title: Does ongoing comprehensive geriatric assessment reduce the incidence of postoperative delirium in older, frail patients undergoing elective inpatient surgery?
    Amount: $149,999
    Stephen Choi MD, FRCPC, MSc

    Stephen Choi MD, FRCPC, MSc

    2022
    Stephen Choi MD, FRCPC, MSc
    Perioperative Brain Health Centre
    University of Toronto
    Sunnybrook Health Sciences Centre
    Grant Title: Redesigning the surgical pathway: optimizing PReOperative assessMent in anesthesia clinic for adulT surgical patients (PROMoTE)
    Award: APSF/ASA President’s Research Award
    Amount: $150,000
    Arnoley Abcejo, MD

    Arnoley Abcejo, MD

    2019
    Arnoley Abcejo, MD
    Mayo Clinic Department of Anesthesiology and Perioperative Medicine
    Grant Title: Neurocognitive Dysfunction after Anesthesia in Patients with Recent Concussion
    Award: APSF/ASA Endowed Research Award
    Amount: $150,000
    Award: Ellison C. Pierce, Jr. MD Merit Award
    Amount: $5,000
    2016
    Jean Wong, MD, FRCP
    Toronto Western Hospital
    Grant Title: Prevention of Delirium in Elderly with Obstructive Sleep Apnea
    $149,000
    APSF/ASA President’s Research Award
    Ellison C. Pierce, Jr. MD Merit Award

     

    Get Involved

    APSF Patient Safety Priority Advisory Groups (PSPAG)Apply to Join an APSF Patient Safety Priority Advisory Group (PSPAG)

    The APSF Patient Safety Priority Advisory Groups guide the APSF Perioperative Patient Safety Priorities and Ongoing Activities. Complete the form to let us know of your interest in joining the advisory groups.