Shedding Light on the Invisible Risk: The Crucial Role of Preoperative Cognition in Postoperative Delirium

Comment on: Preoperative cognitive status is a major contributing factor to postoperative delirium in cardiac surgery: A post-hoc analysis of a prospective study.Perioperative neurocognitive disorders (PNDs) stand as the leading surgical complication among older patients undergoing surgery 1 .Within this spectrum, postoperative delirium (POD) represents a major acute manifestation, especially prevalent in high-risk populations such as those undergoing cardiac surgery.POD is not only clinically significant but is also one of the most prominent and distressing patient-reported outcome measures (PROMs), as it harms recovery, leads to longer hospital stays and raises mortality risks while causing long-term cognitive deterioration.Despite its serious clinical and economic implications, predictive factors for POD remain incompletely understood and are not consistently assessed in routine practice.The recent article by Momeni et al., "Preoperative cognitive status is a major contributing factor to postoperative delirium in cardiac surgery: A post-hoc analysis of a prospective study", contributes essential insight by emphasizing preoperative cognitive status as a powerful, yet often under-recognized, predictor of POD 2 .The incidence of POD following cardiac surgery is reported to be as high as 50%, contributing significantly to postoperative complications, extended hospital stays, and increased mortality 3,4 .Current predictive models focus mainly on age-related factors, together with comorbidities, surgical complexity , and intraoperative elements.Cardiac surgery patients who experience preoperative depression and have multiple health conditions and advanced age have been documented as at risk for developing postoperative delirium according to repeated studies 5 .However, cognitive reserve-the brain's resilience to pathological damage-functions as both a protective factor against postoperative delirium (POD) and as a risk factor that can be modified to prevent this condition 6 .The study by Momeni et al. challenges the traditional focus on purely physiological predictors and redirects attention toward the brain.It reminds us that cognitive resilience may be just as critical as cardiac reserve in preparing patients for surgery.By framing preoperative cognitive status not just as a marker but as a modifiable and actionable element, the study strengthens the case for preoperative neuro-prehabilitation and for developing real-world, brain-protective strategies throughout the perioperative period.The authors conducted a thorough post-hoc analysis of prospectively gathered data to prove that initial cognitive impairment directly links to POD occurrence in cardiac surgery patients.The analysis shows that cognitive assessment provides distinct and cumulative value to perioperative risk evaluation because it persists as a significant predictor after controlling for established clinical factors.These findings support the implementation of brain function protective measures as a preventive approach, which should become part of standard preoperative procedures. Shedding Light on the Invisible Risk: The Crucial Role of Preoperative Cognition in Postoperative Delirium