With more than 46 million Americans over the age of 65, postoperative delirium is a major public health issue in this vulnerable population.
In 2015, then-ASA President Daniel J. Cole, M.D., proposed a new patient safety initiative — the Brain Health Initiative — to engage a multidisciplinary group to work with providers, payers and the public to create a low-barrier access program to minimize the impact of pre-existing cognitive deficits, and optimize the cognitive recovery and perioperative experience for adults 65 years and older undergoing surgery.
Postoperative delirium and delayed cognitive recovery are complications of significance to the elderly surgical population.
The incidence of postoperative delirium ranges from 5 to 15 percent. However, with certain high-risk groups such as patients with hip fracture, the range can be between 16 to 62 percent.
Immediately after surgery, the incidence of delayed cognitive recovery is high with recovery over a period of months.
Postoperative delirium is associated with significant postoperative complications.
ASA's PBHI Mission
To create a low-barrier access program to minimize the impact of pre-existing cognitive deficits and optimize the cognitive recovery and perioperative experience for older adults (65 years and older) undergoing surgery.
To make available a three-year comprehensive plan that anesthesiology departments can follow to become centers of excellence.
To create a campaign through which all anesthesiologists have greater awareness of the importance of preoperative screening for cognitive deficit and of appropriate protective measures to minimize impact on cognitive function during the perioperative period.
To provide a stepped implementation program supported by tools. Some departments may choose to implement years one to three at an accelerated pace, including consideration of intraoperative monitoring of the brain. However, the intention of this campaign is to ensure widespread early adoption of the simplest evidence-based methods of cognitive protection.