To

limit the scope to the hospital inpatient setting, emergency department, ambulatory, or outpatient settings, the community, postacute or long-term care (nursing homes), and hospice settings were excluded. Only observational studies or randomized clinical trials were included. To select the final included studies, the two co-chairs screened all of the abstracts found by the search. Consensus of the study co-chairs was used to choose the final BI-2536 studies for inclusion, which were then reviewed and approved by panel members. Evidence tables and quality ratings were completed for each selected article. Working groups of the panel then developed evidence-based recommendation statements over a ten-month period through two in-person meetings, ongoing subgroup communication, and three full-panel conference calls. Recommendation statements were structured as recommended by the Institute of Medicine guideline development advisory publication.23 The full panel participated in evolving the recommendation statement drafts as described. The best practices statements underwent peer review by both surgical and nonsurgical experts in geriatric medicine and surgery. Additional peer review was provided by 29 surgical and nonsurgical organizations with special interest and expertise in the treatment and prevention of postoperative delirium (see Appendix

2A, online only). The recommendation statements are meant for all health care professionals caring for older adults in the perioperative www.selleck.co.jp/products/erastin.html setting. selleck screening library In all cases, these guidelines

are not intended to supersede clinical judgment or individual patient choices or values. Ultimately, clinical decision-making must always be customized to the individual situation. Health care professionals caring for surgical patients should perform a preoperative assessment of delirium risk factors, including age>65 years, chronic cognitive decline or dementia, poor vision or hearing, severe illness, and presence of infection. The risk of developing delirium following surgery is best described as a relationship between a physiologic stressor and predisposing patient risk factors.24 In the context of surgery, the physiologic stressor is mainly determined by the extent of the operation. Risk factors for postoperative delirium are well established. The National Institute for Health and Care Excellence (NICE) issued a delirium clinical guideline that highlighted five major risk factors for delirium (reported with odds ratios): age>65 years (OR 3.03; 95% CI 1.19–7.71), chronic cognitive decline or dementia (OR 6.30; 95% CI 2.89–13.74), poor vision (OR 1.70; 95% CI 1.01–2.85) or hearing, severe illness (OR3.49; 95% CI 1.48–8.23), and the presence of infection (OR 2.96; 95% CI 1.42–6.16).