The Impact of Preoperative Renal Impairment on the Incidence of Postoperative Delirium: A Systematic Review and Meta-Analysis

BackgroundPostoperative delirium is common in elderly patients following major surgery. This study aimed to assess the effect of transcutaneous electrical acupoint stimulation combined with auricular acupressure on the incidence of postoperative delirium among older patients undergoing major abdominal surgery.MethodsIn this single-center, randomized controlled clinical trial, 210 patients aged 65 years or older undergoing major abdominal surgery were randomized to receive either intervention treatment (transcutaneous electrical acupoint stimulation started at 30 min before anesthesia until the end of the surgery, followed by intermittent auricular acupressure in the first three postoperative days; n = 105) or standard care (n = 105). The primary outcome was the incidence of delirium at the first seven postoperative days or until hospitalization depended on which came first. Secondary outcomes included delirium severity, opioid consumption, postoperative pain score, sleep quality, length of postoperative hospital stay, and postoperative 30-day complications. Enrollment was from April 2019 to March 2020, with follow-up ending in April 2020.ResultsAll of the 210 randomized patients [median age, 69.5 years, 142 (67.6%) male] completed the trial. The incidence of postoperative delirium was significantly reduced in patients received intervention treatment (19/105 (18.1%) vs. 8/105 (7.6%), difference, –10.5% [95% CI, –1.5% to –19.4%]; hazard ratio, 0.41 [95% CI, 0.18 to 0.95]; P= 0.023). Patients in the control group had a higher postoperative Memorial Delirium Assessment Scale (4 vs. 3; difference, –1; 95% CI, –1 to 0; P = 0.014) and a greater increase in Pittsburgh Sleep Quality Index score from baseline to postoperative day three (2.5 vs. 2.0; difference, –1; 95% CI, –2 to –1; P < 0.001) than patients in the intervention group. No significant difference was observed as of other secondary outcomes.ConclusionIn elderly patients undergoing major abdominal surgery, transcutaneous electrical acupoint stimulation combined with auricular acupressure reduced the incidence of postoperative in-hospital delirium compared with standard care. A multicenter, randomized clinical trial with a larger sample size is necessary to verify these findings.Clinical Trial Registration[https://clinicaltrials.gov], identifier [NCT03726073].

IntroductionThe ideal measures to prevent postoperative delirium remain unestablished. We conducted this systematic review and meta-analysis to clarify the significance of potential interventions.MethodsThe PRISMA statement guidelines were followed. Two researchers searched MEDLINE, EMBASE, CINAHL and the Cochrane Library for articles published in English before August 2012. Additional sources included reference lists from reviews and related articles from 'Google Scholar'. Randomized clinical trials (RCTs) on interventions seeking to prevent postoperative delirium in adult patients were included. Data extraction and methodological quality assessment were performed using predefined data fields and scoring system. Meta-analysis was accomplished for studies that used similar strategies. The primary outcome measure was the incidence of postoperative delirium. We further tested whether interventions effective in preventing postoperative delirium shortened the length of hospital stay.ResultsWe identified 38 RCTs with interventions ranging from perioperative managements to pharmacological, psychological or multicomponent interventions. Meta-analysis showed dexmedetomidine sedation was associated with less delirium compared to sedation produced by other drugs (two RCTs with 415 patients, pooled risk ratio (RR) = 0.39; 95% confidence interval (CI) = 0.16 to 0.95). Both typical (three RCTs with 965 patients, RR = 0.71; 95% CI = 0.54 to 0.93) and atypical antipsychotics (three RCTs with 627 patients, RR = 0.36; 95% CI = 0.26 to 0.50) decreased delirium occurrence when compared to placebos. Multicomponent interventions (two RCTs with 325 patients, RR = 0.71; 95% CI = 0.58 to 0.86) were effective in preventing delirium. No difference in the incidences of delirium was found between: neuraxial and general anesthesia (four RCTs with 511 patients, RR = 0.99; 95% CI = 0.65 to 1.50); epidural and intravenous analgesia (three RCTs with 167 patients, RR = 0.93; 95% CI = 0.61 to 1.43) or acetylcholinesterase inhibitors and placebo (four RCTs with 242 patients, RR = 0.95; 95% CI = 0.63 to 1.44). Effective prevention of postoperative delirium did not shorten the length of hospital stay (10 RCTs with 1,636 patients, pooled SMD (standard mean difference) = -0.06; 95% CI = -0.16 to 0.04).ConclusionsThe included studies showed great inconsistencies in definition, incidence, severity and duration of postoperative delirium. Meta-analysis supported dexmedetomidine sedation, multicomponent interventions and antipsychotics were useful in preventing postoperative delirium.

Editor, We thank Wan et al.1 for their interest in our cohort study on postoperative delirium in patients admitted to the ICU after intracranial surgery2 and appreciate the opportunity to respond. For the diagnosis of postoperative delirium, the Diagnostic and Statistical Manual of Mental Disorders (DSM), fifth edition nomenclature is recommended.3 However, to assist nonpsychiatrically trained clinicians to identify delirium quickly and accurately, several DSM-based instruments have been developed, including the Confusion Assessment Method (CAM)4 and CAM for the ICU (CAM-ICU).5 We used the CAM-ICU for several reasons. All enrolled patients were transferred to the ICU after craniotomy, and all assessments of postoperative delirium were performed in the ICU on postoperative day 1. In our cohort, 2.2% of the patients (18/800, Table 4) were mechanically ventilated when assessing delirium on postoperative day 1, but 27.5% of the patients (220/800, unpublished data used in immobilising factor score) were intubated. As the most widely recognised screening scale of postoperative delirium in the ICU, CAM-ICU is recommended by the American Society of Critical Care Medicine as a delirium assessment tool in adult patients in the ICU6 and is suggested by the European Society of Anaesthesiology as a postoperative delirium screening tool in postoperative patients.7 Therefore, in many cohort and controlled studies, CAM-ICU has been employed as an effective tool for the assessment of postoperative delirium in the ICU.8–11 We agree with Wan et al. that in our study, the incidence of postoperative delirium may have been confounded by the assessment tool and the time window for the monitoring. As we discussed in our article, although previous studies reported that the incidence of postoperative delirium decreased in a time-dependent manner, delirium may occur from postoperative day 4 to day 7 (but less than 5%).11,12 Furthermore, it has been reported that, compared with the Diagnostic and Statistical Manual of the American Psychiatric Association, the sensitivity of CAM-ICU to detect delirium is relatively low in the recovery room setting.7 All these factors may have caused an underestimation of the incidence of postoperative delirium in our cohort. Therefore, our results still indicate the importance of postoperative delirium in the population we studied. Regarding the analysis of risk factors for postoperative delirium, we did follow the overall strategy univariate analyses first (Tables 1 to 4), followed by multivariate analyses (Table 5). Wan et al. may have some misunderstanding of univariate analysis. The main purpose of the univariate analysis is to identify candidate risk factors or covariates, rather than to estimate the size of the effect [the odds ratio (OR) and its 95% confidence interval (CI) were calculated in our study]. Therefore, we can either examine the distribution of variables between the groups or use one independent variable at a time to fit a regression model to identify potential risk factors. We prefer the former because this form of data is more informative with the summary and report of descriptive statistics and the P value in statistical tests. As for the estimation of the effect size, we reported the original and adjusted ORs and 95% CIs of the risk factors in the multivariate logistic regression model in Table 5. These factors are more valuable for preventing postoperative delirium. For more detailed information about our statistical strategy, please refer to other reports.13,14 We used backward stepwise variable selection in multivariate logistic regression because this method can obtain a performance similar to the Bootstrap method, but it is easy to perform.15 We agree with Wan et al. that a number of demographic and peri-operative factors may lead to adverse postoperative outcomes. That is why we did not take the causal relationship between postoperative delirium and adverse consequences as the end point of the study. As we pointed out in the article,2 our data show the potential association between postoperative delirium and adverse outcomes. Considering the relatively high incidence of postoperative delirium and the identified risk factors, our study indicates a comprehensive strategy to prevent postoperative delirium after intracranial surgery. In summary, one study cannot solve all problems. We thank Wan et al. for their suggestions for identifying and investigating safe and effective interventions to reduce the incidence, duration and severity of postoperative delirium, which might provide the readers with more information. With the help of all the readers, we will keep working on postoperative delirium issues to figure it out.

Background and aimsThere are various reports on the effect of the anesthetic method on neurologic complication. Especially, there is controversy about the effect of general anesthesia and regional anesthesia on...

Postoperative delirium is the most common postoperative complication in the elderly. The purpose of this study was to evaluate the safety and effectiveness of the preventive administration of low-dose haloperidol on the development of postoperative delirium after abdominal or orthopedic surgery in elderly patients. A total of 119 patients aged 75 years or older who underwent elective surgery for digestive or orthopedic disease were included in this study. Patients were divided into those who did (intervention group, n = 59) and did not (control group, n = 60) receive 2.5 mg of haloperidol at 18:00 daily for 3 days after surgery; a randomized, open-label prospective study was performed on these groups. The primary endpoint was the incidence of postoperative delirium during the first 7 days after the operation. The incidence of postoperative delirium in all patients was 37.8%. No side effects involving haloperidol were noted; however, the incidences of postoperative delirium were 42.4 and 33.3% in the intervention and control groups, respectively, which were not significantly different (p = 0.309). No significant effect of the treatment was observed on the severity or persistence of postoperative delirium. The preventive administration of low-dose haloperidol did not induce any adverse events, but also did not significantly decrease the incidence or severity of postoperative delirium or shorten its persistence.

BackgroundPostoperative delirium is a common complication in patients after cardiac surgery, especially in older patients, and can manifest as a disturbance of attention and consciousness. It can lead to increased postoperative morbidity, prolonged need for care, and mortality. The presented study investigates whether the occurrence of postoperative delirium after cardiac surgery can be prevented by a multisensory stimulation. It was conducted as a prospective, randomized, controlled, non-pharmacological intervention study in the years 2021 and 2022 at the University Hospital Bonn in Germany. A total of 186 patients over 65 years with elective cardiac surgery were enrolled. Patients were randomized either to the intervention or control group. In both groups, postoperative delirium was assessed with the 3-min diagnostic interview for confusion assessment method on the first 5 days after surgery and pain was assessed using the Numeric Rating Scale. Multisensory stimulation was performed 20 min a day for the first three postoperative days in the intervention group.ResultsThe incidence of postoperative delirium was 22.6% in the intervention group and 49.5% in the control group (p < 0.001). Duration of postoperative delirium was significantly shorter in the intervention group (p < 0.001). Stay in the intensive care unit was significantly longer in the control group (p = 0.006). In the regression model non-intervention, high pain scores, advanced age, and prolonged mechanical ventilation were associated with postoperative delirium (p = 0.007; p = 0.032; p = 0.006; p = 0.006, respectively).ConclusionsResults of the study imply that a multisensory stimulation done on the first 3 days after planned cardiac surgery can reduce the incidence and duration of postoperative delirium in older patients. Influence of the treatment on the incidence of delirium in other patient groups, the length of stay in the intensive care unit, and patients´ postoperative pain should be confirmed in further clinical studies.Trial registration: DRKS, DRKS00026909. Registered 28 October 2021, Retrospectively registered, https://drks.de/search/de/trial/DRKS00026909.

To determine whether the postoperative administration of tryptophan would be beneficial for elderly adults undergoing surgery who are at risk of developing postoperative delirium. Randomized, double-blind, placebo-controlled trial. Denver Veterans Affairs Medical Center. Individuals aged 60 and older undergoing major elective operations requiring a postoperative intensive care unit (ICU) admission (n=325). L-tryptophan, 1g orally three times a day or placebo was started after surgery and continued for up to 3days postoperatively. Delirium and its motor subtypes were measured using the Confusion Assessment Method-Intensive Care Unit (CAM-ICU) and the Richmond Agitation and Sedation Scale. The primary outcome for between-group comparison was the incidence of excitatory (mixed and hyperactive) postoperative delirium. The secondary outcomes for comparison were the incidence and duration of overall postoperative delirium. The overall incidence of postoperative delirium was 39% (95% confidence interval=34-44%) (n=116). Seventeen percent of participants in the tryptophan group and 9% in the placebo group had excitatory delirium (P=.18), and the duration of excitatory delirium was 3.3±1.7days for tryptophan and 3.1±1.9days for placebo (P=.74). Forty percent of participants in the tryptophan group and 37% in the placebo group had overall delirium (P=.60), and the duration of overall delirium was 2.9±1.8days for tryptophan and 2.4±1.6days for placebo (P=.17). Postoperative tryptophan supplementation in older adults undergoing major elective operations requiring postoperative ICU admission did not reduce the incidence or duration of postoperative excitatory delirium or overall delirium.

To study the effectiveness of haloperidol prophylaxis on incidence, severity, and duration of postoperative delirium in elderly hip-surgery patients at risk for delirium. Randomized, double-blind, placebo-controlled trial. Large medical school-affiliated general hospital in Alkmaar, The Netherlands. A total of 430 hip-surgery patients aged 70 and older at risk for postoperative delirium. Haloperidol 1.5 mg/d or placebo was started preoperatively and continued for up to 3 days postoperatively. Proactive geriatric consultation was provided for all randomized patients. The primary outcome was the incidence of postoperative delirium (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Confusion Assessment Method criteria). Secondary outcomes were the severity of delirium (Delirium Rating Scale, revised version-98 (DRS-R-98)), the duration of delirium, and the length of hospital stay. The overall incidence of postoperative delirium was 15.8%. The percentage of patients with postoperative delirium in the haloperidol and placebo treatment condition was 15.1% and 16.5%, respectively (relative risk=0.91, 95% confidence interval (CI)=0.6-1.3); the mean highest DRS-R-98 score+/-standard deviation was 14.4+/-3.4 and 18.4+/-4.3, respectively (mean difference 4.0, 95% CI=2.0-5.8; P<.001); delirium duration was 5.4 versus 11.8 days, respectively (mean difference 6.4 days, 95% CI=4.0-8.0; P<.001); and the mean number of days in the hospital was 17.1+/-11.1 and 22.6+/-16.7, respectively (mean difference 5.5 days, 95% CI=1.4-2.3; P<.001). No haloperidol-related side effects were noted. Low-dose haloperidol prophylactic treatment demonstrated no efficacy in reducing the incidence of postoperative delirium. It did have a positive effect on the severity and duration of delirium. Moreover, haloperidol reduced the number of days patients stayed in the hospital, and the therapy was well tolerated.

Delirium is an acute cognitive change characterized by behavioral and psychological features, such as visual and auditory hallucinations, sleep disturbances, and emotional confusion. It can lead to extended hospital stays, increased mortality risk, and higher nursing costs. In postoperative hip fracture patients, delirium results in a higher complication rate, poorer functional recovery, increased readmission rates, repeat surgeries, and elevated mortality. Despite these serious consequences, the literature provides limited information on the incidence of postoperative delirium following hip fracture surgeries in Asians. Additionally, there is a lack of long-term, comprehensive nationwide population-based studies, highlighting an important area for future research. This study aims to understand the incidence and risk factors of postoperative delirium in hip fracture patients using representative population data. We conducted a retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2009 to 2020. The cohort consisted of 118,682 patients aged 65years or older who were diagnosed with hip fractures. The delirium incidence was observed per 1000 person-years. The Cox proportional hazards model was used to investigate the incidence of delirium among hip fracture patients. The incidence of the first episode of delirium after hip surgery in the elderly was 1.87 events per 1000 PYs. Factors associated with delirium included being female (adjusted hazard ratio [aHR]: 0.59; 95% confidence interval [CI]: 0.53-0.64), age ≥95years (aHR: 3.52; 95% CI: 2.74-4.51), comorbid dementia (aHR: 2.63; 95% CI: 2.38-2.92), and ICU stay 2-3days (aHR: 2.85; 95% CI: 1.28-6.37). The occurrence of delirium was significantly associated with an ICU stay of ≥4days, dementia, as well as 30-day, 90-day, and 1-year mortality (p<0.001). This study highlights the relatively low incidence of postoperative delirium in elderly hip fracture patients in Taiwan. Key risk factors identified include advanced age, female gender, comorbid dementia, and prolonged ICU stays. These findings underscore the need for targeted prevention and early intervention strategies to improve patient outcomes.

Objective To analyze the incidence and risk factors of postoperative delirium (POD) in patients with glioma and to explore the association between WHO (World Health Organization) tumor grades and POD. Methods A second analysis of clinical data from 113 adult glioma patients in a single-center, prospective cohort study of 800 neurosurgery patients was conducted from March 2017 to February 2018 at Department of Critical Medicine (ICU), Beijing Tiantan Hospital, Capital Medical University. Patients were assessed for delirium on the first to third days post surgery (twice a day) using the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU). The patient was divided into delirium group (43 cases) and non-delirium group (70 cases) by whether the patient had had delirium. We collected the patient’s general preoperative information, preoperative condition, early postoperative clinical data, and neurosurgical specialty data (including WHO grades) as potential risk factors that may be associated with the occurrence of POD. The independent risk factors of POD were identified using multivariate logistic regression analysis. In particular, the relationship between WHO glioma grade and POD was explored. Results In 113 glioma patients who were admitted to the ICU for routine postoperative monitoring, the incidence of POD was 38.1% (43/113). The incidence of POD in patients with WHO grade Ⅰ-Ⅳ gliomas increased with the increase of the WHO grade: 7.7% (1/13), 14.3% (3/21), 22.7% (5/22) and 63.0% (34/57). Among the potential risk factors, age (OR=1.08, 95% CI: 1.04-1.13, P<0.001), GCS (Glasgow coma scale) score at admission to ICU (OR=0.80, 95% CI: 0.71-0.90, P<0.001) and the WHO grade of tumor (OR=2.01, 95% CI: 1.03-3.92, P=0.041) was independent risk factors for POD. Conclusions The WHO grade of glioma is an independent risk factor for POD. With the increase of tumor grade, the incidence of POD also increases. Key words: Glioma; Neurosurgical procedures; Delirium; Neoplasm grading; Compensa-tory neuroplasticity

Retrospective clinical review and prospective report of postoperative delirium after cervical spine surgeries. To investigate factors contributing to the development of delirium after cervical surgery and see whether amended therapeutic protocols could improve or alter postoperative outcomes. Important consequences of postoperative delirium for the orthopedic patients include impaired recovery and increased morbidity and mortality. Although its risk factors have been reported in orthopedic surgery, there are a very few reports regarding postoperative delirium in spine surgery. Eighty-one cervical myelopathy patients were retrospectively examined about the incidence of postoperative delirium and the risk factors. Similarly, 41 patients who received postoperative care under modified protocols were prospectively examined. Postoperative delirium occurred more commonly in patients over 70 years and those with hearing impairment. Patients who received high-dose methylprednisolone (>1000 mg) demonstrated an increased incidence of postoperative delirium. Under modified protocol, we reduced the usage of methylprednisolone and encouraged free body movement with cervical orthosis immediately after surgery. The incidence of postoperative delirium was significantly lower under the modified protocol. Early commencement of mobilization after cervical spine surgery would be crucial to the prevention of postoperative delirium in the elderly.

Objective To investigate the effects of dexmedetomidine on postoperative delirium in elderly patients undergoing total hip arthroplasty. Methods A total of 100 patients, 42 male and 58 female, ages 60 to 85 years, American Society of Anesthesiologists grade I or II, who were undergoing total hip arthroplasty were randomly divided into 2 groups: a dexmedetomidine group (group D; n = 50) and a control group (group C; n = 50). Group D patients were infused with 0.3 μg · kg−1 · h−1 of dexmedetomidine from 5 minutes prior to anesthesia induction until the end of surgery. Group C patients received an equal volume of saline. Heart rate and mean arterial pressure (MAP) were recorded before anesthesia induction (T0), 1 minute before extubation (T1), and 30 minutes after extubation (T2). The Visual Analog Score (VAS) at 1, 2, and 3 days after surgery, the incidence and duration of postoperative delirium, and the length of hospital stay were recorded. Adverse reactions, such as nausea, vomiting, and lethargy, were also recorded. Results The Visual Analog Scores in the 2 groups were similar. In group D, there was no significant difference in heart rate (P = 0.232) and MAP (P = 0.056) between T0 and T1. However, in group C, heart rate significantly increased by 15.3 bpm (P = 0.000) and MAP significantly increased by 10.7 mmHg (P = 0.001) at T1 compared with those at T0. The incidence of postoperative delirium in group D (10%) was significantly lower than that in group C (26%; P = 0.037). The duration of delirium in group D (1.3 ± 0.6 days) was shorter than that in group C (3.0 ± 0.5 days; P = 0.000). The length of hospital stay in group D (13.2 ± 0.9 days) was shorter than that in group C (16.1 ± 0.7 days; P = 0.000). No significant differences were observed in adverse effects between the 2 groups. Conclusion Intravenous infusion of dexmedetomidine can not only reduce the incidence and duration of postoperative delirium, but also shorten the length of hospital stay in elderly patients undergoing total hip arthroplasty.

BackgroundPOD places a heavy burden on the healthcare system as the number of elderly people undergoing surgery is increasing annually because of the aging population. As a large country with a severely aging population, China's elderly population has reached 267 million. There has been no summary analysis of the pooled incidence of POD in the elderly Chinese population.MethodsSystematic search databases included PubMed, Web of Science, EMBASE, Cochrane Library Databases, China Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Database (CBM), WanFang Database, and Chinese Science and Technology Periodicals (VIP). The retrieval time ranged from the database's establishment to February 8, 2023. The pooled incidence of delirium after non-cardiac surgery was calculated using a random effects model. Meta-regression, subgroup, and sensitivity analyses were used to explore the source of heterogeneity.ResultsA total of 52 studies met the inclusion criteria, involving 18,410 participants. The pooled incidence of delirium after non-cardiac surgery in the elderly Chinese population was 18.6% (95% CI: 16.4–20.8%). The meta-regression results revealed anesthesia method and year of publication as a source of heterogeneity. In the subgroup analysis, the gender subgroup revealed a POD incidence of 19.6% (95% CI: 16.9–22.3%) in males and 18.3% (95% CI: 15.7–20.9%) in females. The year of publication subgroup analysis revealed a POD incidence of 20.3% (95% CI: 17.4–23.3%) after 2018 and 14.6 (95% CI: 11.6–17.6%) in 2018 and before. In the subgroup of surgical types, the incidence of hip fracture surgery POD was 20.7% (95% CI: 17.6–24.3%), the incidence of non-cardiac surgery POD was 18.4% (95% CI: 11.8–25.1%), the incidence of orthopedic surgery POD was 16.6% (95% CI: 11.8–21.5%), the incidence of abdominal neoplasms surgery POD was 14.3% (95% CI: 7.6–21.1%); the incidence of abdominal surgery POD was 13.9% (95% CI: 6.4–21.4%). The anesthesia methods subgroup revealed a POD incidence of 21.5% (95% CI: 17.9–25.1%) for general anesthesia, 15.0% (95% CI: 10.6–19.3%) for intraspinal anesthesia, and 8.3% (95% CI: 10.6–19.3%) for regional anesthesia. The measurement tool subgroup revealed a POD incidence of 19.3% (95% CI: 16.7–21.9%) with CAM and 16.8% (95% CI: 12.6–21.0%) with DSM. The sample size subgroup revealed a POD incidence of 19.4% (95% CI: 16.8–22.1%) for patients ≤ 500 and 15.3% (95% CI: 11.0–19.7%) for patients > 500. The sensitivity analysis suggested that the pooled incidence of postoperative delirium in this study was stable.ConclusionOur systematic review of the incidence of delirium after non-cardiac surgery in elderly Chinese patients revealed a high incidence of postoperative delirium. Except for cardiac surgery, the incidence of postoperative delirium was higher for hip fracture surgery than for other types of surgery. However, this finding must be further explored in future large-sample studies.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: PROSPERO CRD42023397883.

Delirium after transcatheter aortic valve implantation (TAVI) should be prevented because it is associated with worse patient outcomes. Perioperative administration of benzodiazepines is a risk factor for postoperative delirium; however, the association between remimazolam, a newer ultrashort-acting benzodiazepine for general anesthesia, and postoperative delirium remains unclear. This study aimed to evaluate whether remimazolam administration during TAVI under general anesthesia affected the incidence of postoperative delirium. This single-center retrospective study recruited all adult patients who underwent transfemoral TAVI (TF-TAVI) under general anesthesia between March 2020 and May 2022. Patients were divided into the remimazolam (R) and propofol (P) groups according to the sedative used for anesthesia. In the R group, all patients received flumazenil after surgery. The primary endpoint was the incidence of delirium within 3days after surgery. Factors associated with delirium after TF-TAVI were examined by multiple logistic regression analysis. Ninety-eight patients were included in the final analysis (R group, n = 40; P group, n = 58). The incidence of postoperative delirium was significantly lower in the R group than in the P group (8% vs. 26%, p = 0.032). Multiple logistic regression analysis revealed that remimazolam (odds ratio 0.17, 95% CI 0.04-0.80, p = 0.024) was independently associated with the incidence of postoperative delirium, even after adjustment for age, sex, preoperative cognitive function, history of stroke, and TF-TAVI approach. Remimazolam may benefit TF-TAVI in terms of postoperative delirium; however, its usefulness must be further evaluated in extensive prospective studies.

Delirium after surgical and transcatheter aortic valve replacement is associated with increased mortality