To the Editor.
—I fail to understand the wisdom of excluding input from an anesthesiologist in the design or implementation of the recently published study by Marcantonio et al.1 The authors' attempt to link postoperative delirium to preoperative risk factors without controlling for time of surgery start, anesthetic technique, postoperative analgesic technique, need for continued postoperative ventilation and sedation, and need for postoperative intensive care flies in the face of modern science. For example, many anesthesiologists currently use high-dose opiate techniques for major abdominal vascular repair (ie, aortic aneurysm surgery), and many of these patients spend their first 24 postoperative hours in an intensive care unit. That these patients are at higher risk for postoperative delirium or confusion than a healthy 40-year-old woman undergoing tubal ligation comes as no surprise to any anesthesiologist.The authors' comment that intervention strategies for reducing the probability of postoperative delirium "include close monitoring and
Rozner MA. Preoperative Prediction of Postoperative Delirium. JAMA. 1994;271(20):1573-1574. doi:10.1001/jama.1994.03510440033017