Surgeons must navigate the complex landscape of surgical decision-making for patients with dementia, emphasizing informed choices and collaboration.

• 28 recommendations were developed, with 25 deemed critically important but feasible only in the long-term.
• Consensus among 23 stakeholders highlighted the need for better resources and team-based care for surgical candidates with cognitive impairment.

Prioritize education on dementia in surgical practice to enhance outcomes and effectively support patients and families.

• All 21 research priorities gained high consensus, guiding future studies crucial for improving surgical strategies.

Medicare Advantage plans often limit patient access to surgical specialists, which can affect care delivery and outcomes.

• Among 36,584 counties, the average Medicare Advantage network included only 57.6% of surgical specialists.
• Plastic surgery networks had the least access, averaging 47.1%, while vascular, thoracic, and orthopedic networks exceeded 60%.
• Over 1 million enrollees reside in counties with no in-network surgeons, particularly in rural areas.

Surgeons should consider these access gaps when evaluating care options for Medicare Advantage patients, especially in underserved regions.

Dexmedetomidine is a standout option for preventing postoperative delirium in older adults.

• Overall delirium risk post-surgery is 14.5%.
• Dexmedetomidine shows a significant reduction (odds ratio 0.46) in delirium risk.
• Corticosteroids also reduce delirium severity but do not affect other outcomes like length of stay or mortality.

Be cautious with dexmedetomidine due to potential hypotension and bradycardia. Aim for a balanced approach in drug selection for your surgical patients over 60.

• Other options like melatonin receptor agonists and intranasal insulin show promise but need further validation.