Perioperative Frailty and Postoperative Delirium in Older Surgical Patients: Anesthetic Strategies and Functional Recovery

Abstract

Frailty and postoperative delirium are increasingly recognized as major determinants of adverse outcomes in older surgical patients. This study analyzed the relationship between preoperative frailty, perioperative anesthetic management, postoperative delirium, and functional recovery through an integrative review of contemporary clinical evidence. Scientific literature from major biomedical databases was examined, including randomized clinical trials, cohort studies, systematic reviews, meta-analyses, clinical practice guidelines, and consensus recommendations involving older adults undergoing surgical procedures. The evidence consistently showed that frailty is associated with an increased risk of postoperative delirium, postoperative complications, functional decline, and early mortality. Recent meta-analyses reported approximately two- to threefold greater odds of postoperative delirium among frail patients, while frailty was also associated with higher postoperative morbidity. Randomized trials comparing regional or spinal anesthesia with general anesthesia did not demonstrate a consistent reduction in delirium based solely on anesthetic technique, emphasizing the multifactorial nature of postoperative neurocognitive dysfunction. Selected perioperative strategies, including individualized anesthetic management, avoidance of excessive sedation, physiological optimization, multicomponent delirium prevention, and dexmedetomidine in specific clinical settings, showed potential benefits. Prehabilitation and perioperative exercise programs were additionally associated with reductions in postoperative complications and improvements in functional capacity. These findings support an integrated perioperative model combining frailty and cognitive screening, geriatric optimization, individualized anesthesia, delirium prevention, early mobilization, and rehabilitation. Perioperative success in older adults should therefore include preservation of cognition, mobility, autonomy, and quality of life in addition to traditional surgical outcomes.