American Board of Surgery Qualifying Exam (ABS QE) Practice Test

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In which type of procedures is the incidence of delirium highest in patients over 70 years old?

Cardiac
Orthopedic
Neurological
Gynecological

The correct answer is: Orthopedic

The incidence of delirium is notably highest in patients over 70 years old undergoing orthopedic procedures. This is largely due to several factors inherent to orthopedic surgeries, including the often significant physiological stress of the procedure, prolonged immobility, and the likelihood of regional anesthesia, which can contribute to postoperative cognitive dysfunction. In older adults, orthopedic surgeries such as hip or knee replacements are common due to age-related musculoskeletal issues, and these patients are typically at greater risk for delirium due to pre-existing cognitive impairment, polypharmacy, and the acute nature of postoperative recovery. Additionally, the factors surrounding pain management and rehabilitation in the postoperative period for these surgeries can also lead to confusion and cognitive decline. While cardiac, neurological, and gynecological procedures also carry some risk for delirium, the combination of factors specific to orthopedic procedures escalates the risk in this population more significantly. This includes the demographic characteristics of the patients undergoing these procedures and the overall postoperative environment.