Pipra

An AI-powered solution to predict and prevent postoperative delirium in older patients

The challenge

Postoperative delirium (POD) is a common and serious complication of surgery[1][2], affecting up to 50% of patients over 60 years old[3]. POD is characterized by confusion, agitation, disorganized thoughts, inattention and altered consciousness, and is associated with various adverse outcomes, including a six-fold rise in nursing home admissions, a 13.9-fold increased risk of dementia, prolonged length of stay (LOS), higher readmission rates, functional decline, dependency in activities of daily living, and increased mortality.

Published literature shows that the economic implications of these outcomes are significant, with POD incurring estimated additional costs of up to €25,000 per patient[4] and annual healthcare expenses up to €182 billion in Europe alone[5]. Furthermore, nursing shortages, high workloads, inadequate knowledge of delirium, and the significant challenges of delirium care are leading to a range of negative experiences for nurses caring for patients with delirium, adversely influencing nurses’ physical and mental health.

To address the needs of patients and their families, healthcare professionals, hospital administrators, and international medical societies recommend that health care providers identify patients at high risk for POD in order to provide appropriate preventive measures[6].

The solution

We offer a comprehensive PIPRA delirium management program, which includes the PIPRA POD risk prediction tool, online and on-site staff training, and provision of standardized delirium screening methodologies and targeted MCI measures.

PIPRA is an innovative, scalable, Class IIa CE-certified, AI-based medical device that identifies older patients most at risk of POD. The tool was, developed using individual patient meta-analysis (IPDMA) of a rich, proprietary database with data from more than 2,500 patients, described by Dodsworth et al and Sadeghirad et al in 2023. The tool has a clinically validated predictive performance of over 77% and can be run manually in under 1 minute or integrated into the electronic health record (EHR) as a routine preoperative assessment. Delirium screening methodologies include validated clinical screening tools such as the Delirium Observation Screening Scale or DOSS and MCIs such as the Hospital Elder Life Program (HELP) have been well-described and clinically validated.

The value of the PIPRA delirium management program is its potential 1) to improve surgical outcomes for patients by identifying those who are at high risk and can then receive targeted MCIs, 2) to improve workflow processes for healthcare professionals by enabling them to provide targeted preventive measures to high risk patients only, 3) to reduce healthcare costs for healthcare administrators and hospitals. Indeed, the solution allows international medical guidelines to be put into real life practice, providing identification of high-risk patients and a focused risk reduction protocol for those patients.

Expected impact

Health impact

By embedding PIPRA’s delirium management program into routine care, we anticipate a marked improvement in patient well-being. Over 150,000 older surgical patients across Spain and Germany will be systematically screened, and roughly one-third identified as high-risk will receive targeted preventive measures—helping them avoid acute episodes of confusion and preserving both cognition and independence. Shortened delirium-related hospital stays further reduce the risks of falls, infections, and functional decline, translating into smoother recovery trajectories and fewer readmissions.

For families and caregivers, this translates into a lighter emotional and logistical burden: fewer emergency calls, less time spent navigating hospital corridors, and less anxiety over potential long-term cognitive consequences. At the system level, preventing delirium frees thousands of bed-days each year, alleviating pressure on ICUs and general wards, lowering complication rates, and streamlining care pathways for older adults.

In sum, PIPRA not only forestalls a dangerous and often overlooked brain injury but also delivers tangible benefits for patients, their loved ones, and the healthcare system as a whole.

Economic Impact

From an economic standpoint, deploying PIPRA’s solution costs only a fraction of what is spent on treating a single episode of postoperative delirium. This difference generates substantial net savings for each case prevented, resulting in multi-million-euro cost avoidance across our pilot hospitals and a strong return on investment within the first few years. Moreover, by reducing emergency assessments and rapid-response calls for delirium, PIPRA enhances staff efficiency, freeing nurses and physicians to focus on higher-value clinical activities.

Environmental impact

By enabling targeted prevention of postoperative delirium and shortening hospital stays, PIPRA directly reduces the environmental footprint of surgical care.  Every day a patient spends in hospital generates an estimated 13 tonnes of CO₂ per bed in Spain and 34–37 tonnes per bed in Germany.  Our Swiss pilot data show that PIPRA-driven interventions shave more than a day off average length of stay, translating into a proportional drop in energy use (heating, lighting, laundry) and CO₂ emissions.  Moreover, because the PIPRA algorithm is a lightweight logistic‐regression model with minimal computational demand, it adds virtually no hidden “digital” carbon cost.  In sum, PIPRA not only improves patient outcomes but also advances sustainable, resource‐efficient healthcare.

Contributions to the Sustainable Development Goals (SDGs). While PIPRA has relevance to a number of the SDGs (SDG 3, 10, 11 and 17), our largest contributions are to SDG 3 and SDG 10, Ensure healthy lives and promote well-being for all at all ages and Reduce inequality within and among countries. The development and application of this innovative POD risk prediction tool, together with implementation of MCIs for patients at high risk, helps to reduce the incidence of POD in older adults. This contributes to the overall goal of promoting good health and well-being, especially in an aging population (SDG 3).

External Partners

• PIPRA AG, Activity Leader, commercialization

References

[1] Aldecoa et al., 2024

[2] American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults, 2015

[3] Inouye et al., 2014

[4] Kinchin et al., 2021

[5] Chuan and Sanders, 2021

[6] Hshieh et al., 2018