• Manjot Singh, Maxwell Sahhar, Joseph E Nassar, Michael J Farias, Rhea Rasquinha, Jinseong Kim, Bassel G Diebo, and Alan H Daniels.
• Warren Alpert Medical School, Brown University, Providence, RI.
• Spine. 2025 Jan 30.

Study DesignRetrospective cohort study.ObjectiveEvaluate the utility of Delirium Risk Assessment Score (DRAS), Delirium Risk Assessment Tool (DRAT), and Delirium Elderly At-Risk (DEAR) in patients undergoing posterior lumbar interbody fusions.BackgroundSurgical interventions can place patients at risk for postoperative delirium (POD), an acute and often severe cognitive impairment associated with poor outcomes. However, common risk assessment tools have not been validated in patients undergoing spine surgery.MethodsAdults who underwent posterior lumbar fusion were queried using PearlDiver. Baseline demographics, comorbidities, and delirium occurrence within 7 days of surgery were extracted. Delirium risk scores were calculated using DRAS (15 points total; threshold 5 points), DRAT (8 points total; threshold 3 points), and DEAR (5 points total; threshold 2 points) scales. Receiver operating characteristic (ROC) curves were generated, and optimal risk scores maximizing Youden's Index were established for each measure.ResultsAmong 37,119 patients, 70 patients (0.2%) developed POD. The mean age was 60.1 y, 56.6% were female, and mean Charlson Comorbidity Index (CCI) was 2.1. POD patients had lower mean age and percent female sex, but higher mean CCI and percent medical comorbidities (all P<0.05). ROC curve analyses revealed that a DRAS score of 5 (Sensitivity=62.9%, Specificity=63.9%), DRAT score of 3 (Sensitivity=31.4%, Specificity=81.0%), and DEAR score of 2 (Sensitivity=40.0%, Specificity=82.9%) maximized the Youden's Index value. Patients above these thresholds were 6.0, 2.0, and 3.2 times more likely to develop POD after posterior lumbar fusion, respectively.ConclusionDelirium risk assessments tools were found to be useful in stratifying patients at high risk of POD following posterior lumbar fusion. Specifically, patients above the pre-defined thresholds were 2 to 6 times more likely to develop delirium postoperatively. Careful stratification of patients' risk of delirium using highly sensitive and specific tools like DRAS may guide preoperative surgical planning and postoperative management plans.Level Of EvidenceIV.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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