This is a retrospective study from Japan analysing 102 patients who underwent oral cancer resection and free flap reconstruction. Postoperative delirium occurred in a third of these patients. An increased risk was identified in those with high preoperative albumin, postoperative insomnia and a history of smoking. They suggest that maintaining nutritional status and early management of the sleep cycle postoperatively may be important with prevention of delirium. It is a little strange that in a population with oral squamous cell carcinoma, alcohol is not mentioned, let alone considered, as a risk factor for postoperative delirium in elderly patients undergoing extensive surgery in a disorientating environment.