Care Pathways Combining Anesthesia Practices and Nursing Interventions forPostoperative Delirium Prevention

Abstract

Background:
Postoperative delirium (POD) is a frequent, harmful complication after surgery. Multicomponent pathways that coordinate anesthesia practices with nurse-led prevention strategies are increasingly adopted, yet their effectiveness across surgical settings remains variably reported.
Methods:
A systematic search of PubMed (to July 2025) identified studies evaluating integrated anesthesia-nursing pathways for POD prevention in adult inpatients. Randomized and observational designs were eligible. Primary outcome was POD incidence (validated tools); secondary outcomes included delirium duration, length of stay, pain, sleep quality, and early recovery.
Results:
Thirteen studies met criteria (9 randomized trials and 4 cohorts). Multicomponent pathways frequently reduced POD versus usual care, especially in higher-risk populations. Examples included an antiinflammatory drug bundle in hip-fracture surgery (15% vs 44%; RR =0.33) and esketamine plus dexmedetomidine in thoracic surgery (14.6% vs 30.9%; RR=0.47). A large implementation cohort reported a month-over-month decline in delirium after bundle rollout (adjusted odds ratio 0.96; 95% confidence interval 0.94-0.97). Secondary outcomes generally favored intervention groups, including shorter hospitalization, improved sleep, lower pain, and higher early recovery scores.
Conclusions:
Integrated perioperative pathways that combine anesthesia optimization with nurse-led nonpharmacologic measures were associated with lower delirium and better recovery metrics, whereas single-component changes often showed limited effect. Adoption should emphasize multicomponent design, staff training, and implementation fidelity, with pragmatic trials to standardize effective elements across surgical contexts.