The Perioperative Brain Health Initiative

Introduction

The Perioperative Brain Health Initiative (PBHI), first conceived in 2015 by the American Society of Anesthesiologists (ASA), is a patient safety initiative aimed at addressing the growing concern for perioperative neurocognitive disorders in older patients. For example, postoperative delirium occurs in approximately 20% to 50% of older surgical patients and is associated with increased mortality, prolonged hospitalization, and cognitive and functional decline. After hospital discharge, cognitive impairment may continue in some patients. Postoperative neurocognitive disorder occurs between 30 days and 12 months after discharge and is defined by a decline in cognitive function identified via standardized neuropsychological tests. Such impairment may occur in up to 40% of older patients after major surgery and is associated with reduced quality of life, depression, and functional impairment. As surgical populations continue to age, neurocognitive complications are expected to persist, and programmatic initiatives are required to mitigate such adverse perioperative outcomes and long-term consequences.

In this context, the mission of the PHBI is to improve brain health in surgical patients through the following aims: (1) Create an accessible program, with supportive tools and resources, to minimize the perioperative impact on cognitive function and trajectory; (2) develop a comprehensive blueprint for anesthesia departments to follow for achieving excellent care; (3) raise awareness for the importance of perioperative brain health among anesthesiologists, perioperative clinicians, and patients; and (4) provide an implementation strategy for the program that can be adopted by various healthcare systems. This chapter will provide an overview of the PBHI, results of implementation strategies to date, and future areas for further development and investigation.