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Postoperative delirium from surgical complication — SCE Geriatric Medicine MCQ

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HardSurgical liaisonPostoperative delirium from surgical complicationSCE Geriatric Medicine

An 85-year-old man with moderate frailty is recovering after emergency laparotomy for bowel obstruction. He is now day 5 post-op with new confusion, oxygen requirement 2 L/min, CRP 240 mg/L and a tender distended abdomen. The surgical team asks whether this is expected postoperative delirium. What is the most important next step?

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Correct answer: A — Escalate urgently for assessment of postoperative complication while managing delirium supportively

Delirium after surgery is common, but new oxygen requirement, high inflammatory markers and abdominal findings suggest a serious postoperative complication such as leak, abscess or ileus. Delirium should trigger a search for underlying causes rather than be labelled as expected. Antipsychotics do not treat sepsis or surgical pathology. The pearl is that delirium may be the presenting sign of surgical deterioration in older adults.

Reference: NICE CG103; NELA perioperative standards; JRCPTB geriatric curriculum