Postoperative Delirium Research Articles

Preoperative geriatric nutritional risk index as a predictor of postoperative delirium in revision arthroplasty: a 10-year retrospective cohort study

ObjectiveThis study aims to investigate the association between the preoperative geriatric nutritional risk index (GNRI) and postoperative delirium (POD) in patients undergoing hip or knee revision arthroplasty.Methods820 patients who underwent hip or knee revision arthroplasty from January 2014 to September 2024 were included. The exposure variable was preoperative GNRI, and the outcome variable was POD, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria using the Confusion Assessment Method (CAM). The study considered covariates such as age, sex, body mass index, albumin, and comorbidities, employing multivariate logistic regression analysis to explore the association between preoperative GNRI and POD.ResultsAmong 820 patients, 76 (9.27%) developed POD within 7 days postoperatively. Patients with POD had a significantly lower GNRI (97.53 ± 9.54) compared to those without POD (101.05 ± 8.85, p = 0.003). For each 1-unit increase in GNRI, the risk of POD decreased by 4% (OR = 0.96, 95% CI: 0.94–0.99, p = 0.011). Quartile analysis showed that patients in the highest GNRI quartile had a significantly lower POD incidence compared to those in the lowest quartile (OR = 0.43, 95% CI: 0.20–0.92, p for trend = 0.037). A protective threshold of GNRI was identified at 101.96.ConclusionA significant association was observed between preoperative GNRI and POD in patients undergoing hip or knee revision arthroplasty. However, due to the retrospective single-center design and potential unmeasured confounding, further multicenter prospective studies are warranted to validate these findings and explore underlying mechanisms.

Targeting complement C3/C3aR pathway restores rejuvenation factor PF4 and mitigates neurocognitive impairments in age-related perioperative neurocognitive disorders.

Perioperative neurocognitive disorders (PND), including postoperative delirium (POD), delayed neurocognitive recovery (dNCR) and postoperative neurocognitive disorder (PNCD), affect up to 10% of surgical patients older than 60 years, and currently there are no effective therapies to prevent PND. The gut microbiota is linked to PND through the gut-brain axis, promoting neuroinflammation via activation and proliferation of microglia and astrocytes in the central nervous system (CNS). In this study, we show that perioperative use of ceftriaxone, a long-acting β-lactam antibiotic, can prevent the development of PND in elderly surgical patients. This effect is associated with reduced serum complement C3 levels and increased levels of platelet factor 4 (PF4). Using an aged mouse model of PND, we found that C3/C3aR axis mediated the interaction of astroglia and microglia during the early stages of neuroinflammation. Genetic ablation or pharmacological blockade of C3/C3aR signaling pathway suppressed neuroinflammation and attenuated cognitive declines in PND. The C3/C3aR axis is essential for surgery-induced platelet count and circulating PF4 declines, and mice supplemented with recombinant PF4 exhibited reduced neuroinflammation and improved cognitive function. Together, our findings revealed the new roles of the C3/C3aR signaling pathway in platelet dysfunction and neuroinflammation in age-related PND, and these results highlight new potential therapeutic strategies for PND.

Relationship between duration of intraoperative hypotension and postoperative delirium in patients undergoing head and neck cancer surgery with free flap reconstruction: a retrospective observational study

Abstract Purpose Postoperative delirium (POD) is a frequent complication after surgery, especially in elderly patients undergoing head and neck cancer surgery with free flap reconstruction. This study aimed to assess the associations between intraoperative hypotension (IOH), its duration, and occurrence of POD. Methods This retrospective study included 239 patients aged 65 years or older who underwent head and neck cancer surgery with free flap reconstruction. IOH was defined at seven mean arterial pressure (MAP) thresholds, ranging from 55 to 85 mmHg, in 5 mmHg increments. The duration of each IOH was compared between patients with or without POD before and after initiation of microsurgery. Multivariate analysis was conducted to assess the independent association of each IOH duration with the risk of POD. Results POD occurred in 43 (18.0%) of the 239 patients. Before the initiation of microsurgery, the cumulative duration of hypotension below MAP thresholds of < 70 to 80 mmHg was significantly longer in patients with POD. After the initiation of microsurgery, the cumulative duration of hypotension below MAP thresholds of < 55 to 85 mmHg was also significantly longer in patients with POD. In multivariate analysis, the cumulative duration of hypotension below MAP thresholds of 70, 75, and 80 mmHg before and after the initiation of microsurgery was independently associated with POD (p < 0.05 at each threshold). Conclusion Prolonged IOH, particularly below MAP thresholds of 70, 75, and 80 mmHg, was significantly associated with POD in elderly patients undergoing head and neck cancer surgery with free flap reconstruction.

The impact of cognitive function and depression on postoperative delirium risk in elderly patients undergoing major abdominal surgery.

Postoperative delirium (POD) is a frequent neuropsychiatric disorder characterized by sudden onset, particularly in elderly patients. The aim of this study is to assess the relationship between cognitive function, depression status, and the risk of POD in geriatric patients undergoing major abdominal surgery. This prospective cohort study included 100 patients aged 65 years and older who underwent major abdominal surgery. Preoperatively and postoperatively, patients underwent cognitive assessments using the mini-mental state examination (MMSE), geriatric depression scale (GDS), three-word recall test, and clock drawing test. Demographic data and test results were subsequently analyzed statistically. The mean age of the participants was 70.8 ± 5.9 years. POD occurred in 18% of patients. Statistically significant differences were observed between preoperative and postoperative values for MMSE, GDS, and clock drawing test (P < .001). Postoperative GDS results showed a significantly lower rate of normal results in the delirium group (16.7%) compared to the non-delirium group (52.4%) (P = .021). Each 1-unit decrease in preoperative MMSE score was associated with an approximately 10-fold increase in the risk of delirium (OR: 9.7; 95% CI: 1.3-71.4). In conclusion, major abdominal surgery can increase depression and impair cognitive function in elderly individuals. POD is a common complication in the elderly, with significant health consequences. The MMSE may be a useful tool for predicting the risk of postoperative delirium.

Letter to editor on "Impact of tourniquet application on postoperative delirium in elderly patients undergoing total knee arthroplasty: a randomized clinical trial".

Letter to editor on "Impact of tourniquet application on postoperative delirium in elderly patients undergoing total knee arthroplasty: a randomized clinical trial".

Hydromorphone Versus Fentanyl-Based Induction of Anesthesia for Postoperative Pain and Emergence Delirium in Children Undergoing Strabismus Surgery: A Randomized, Double-Blind Comparative Study.

This study aimed to investigate the effects of hydromorphone and fentanyl-based induction of anesthesia for immediate postoperative analgesia in pediatric patients. This was a prospective, double-blind, randomized controlled trial. 186 preschool children aged 3 to 7 years old scheduled for strabismus surgery were randomized to receive hydromorphone 0.02 mg/kg (hydromorphone group; n = 80) or fentanyl 3 μg/kg (fentanyl group; n = 80). The primary outcome was the Face, Legs, Activity, Cry, and Consolability (FLACC) pain score at extubation. Secondary outcomes included the incidence of postoperative emergence delirium (ED), the proportion of subjects who received rescue analgesia, Ramsay sedation scores, heart rate, mean arterial pressure, and SpO2 in post-anesthesia care unit, and perioperative adverse events. From November 10, 2020, to May 26, 2022,186 patients at West China Hospital were enrolled, 153 (37.5% male) of whom received administration of fentanyl (n = 76) or hydromorphone (n = 77). The hydromorphone group showed lower FLACC pain scores at the time of extubation (median [IQR], hydromorphone vs. fentanyl, 0 [0-0] vs. 0 [0-1], Mann-Whitney U = 2457.0, Z = -2.469, p = 0.014). The incidence of ED in the hydromorphone group was statistically lower than that in the fentanyl group (75.3% vs. 93.4%, p = 0.004, relative risk and 95% CI was 0.8 (0.7, 0.9)). Other secondary outcomes were comparable between the two groups. Hydromorphone administration during induction may improve postoperative pain control and reduce the incidence of ED in PACU after pediatric strabismus surgery. This study was registered at the Chinese Clinical Trials Register (www.chictr.org.cn) (number: ChiCTR2000039555, date of registration: 31/10/2020).

Dexmedetomidine for preventing postoperative delirium in neurosurgical patients: a meta-analysis of randomized controlled trials.

Dexmedetomidine for preventing postoperative delirium in neurosurgical patients: a meta-analysis of randomized controlled trials.

Cardiovascular health score and its association with postoperative delirium: evidence from the Kailuan study

BackgroundIdentifying modifiable risk factors for postoperative delirium (POD) is essential for prevention and management. The Ideal Cardiovascular Health Score (CHS), a composite measure of cardiovascular health, has been shown to reduce the risk of various chronic diseases. However, its association with POD has not been extensively explored. This study aims to examine the relationship between CHS and the risk of POD in a cohort of surgical patients.MethodsData from the Kailuan Study, a large longitudinal cohort, were used for this analysis. A total of 1,082 participants aged 18–98 years, who underwent non-cardiac surgery under general anesthesia from 2016 to 2021, were included. The CHS was calculated based on seven cardiovascular health metrics: smoking status, body mass index (BMI), physical activity, diet, blood pressure, fasting blood glucose (FBG), and total cholesterol (TC). POD was diagnosed using the Confusion Assessment Method (CAM). Multivariable logistic regression was employed to assess the association between CHS scores and POD, adjusting for potential confounders.ResultsAmong the 1,082 participants, 120 developed POD. Higher CHS scores were inversely associated with the risk of POD. Participants with a CHS ≥ 10 had 55% lower odds of developing POD compared to those with a CHS ≤ 7 (OR = 0.45; 95% CI: 0.23–0.89). This protective effect was observed across various subgroups, including age, sex, and alcohol consumption status. Specific CHS components, such as normal blood pressure (OR = 0.49; 95% CI: 0.31–0.78) and FBG &amp;lt; 5.6 mmol/L (OR = 0.65; 95% CI: 0.47–0.94), were independently associated with reduced POD risk.ConclusionA higher CHS score is associated with a lower risk of POD, highlighting the potential protective role of cardiovascular health in preventing postoperative complications.

Relationship between telomere length and postoperative delirium: a single center prospective observational pilot study

Shorter telomere length (TL) and postoperative delirium (POD) are associated with aging and inflammation. We hypothesized that shorter TL may predict POD development. This pilot study investigated whether preoperative TL can predict POD occurrence. This single-center, prospective, observational study included 50 patients aged > 65 years scheduled for postoperative intensive care unit stay ≥ 2 days. Patients with Intensive Care Delirium Screening Checklist scores ≥ 4 were categorized into the POD group. Multivariable logistic regression analyses evaluated preoperative TL as a predictor of POD. Ten patients developed POD (POD group) while 40 did not (non-POD group). Preoperative TL showed no significant difference between groups (POD vs. non-POD: 296,502 vs. 327,884 RLU/µg DNA, p = 0.104). However, multivariable analyses revealed that preoperative TL ≥ 309,110 RLU/µg DNA significantly associated with decreased POD risk after adjusting for age (aOR: 0.132; 95% CI: 0.022–0.799; p = 0.047) and preoperative MMSE score (aOR: 0.153; 95% CI: 0.028–0.851; p = 0.032). Shorter preoperative TL was associated with POD development after adjusting for age and preoperative cognitive function. Future studies with larger sample sizes are needed to confirm these associations.

Postoperative Delirium in Older Adults Undergoing Noncardiac Surgery

Understanding the association of postoperative delirium with adverse outcomes and the hospital-level variation of postoperative delirium is important for efforts to improve perioperative brain health. To examine (1) the association of postoperative delirium with 30-day mortality and complications and (2) hospital-level variation in postoperative delirium. This retrospective cohort study examined hospitalizations among patients aged 65 years and older who underwent noncardiac surgery in US hospitals between January 1, 2017, and December 31, 2020. Data were analyzed between August 28, 2024, and April 10, 2025. Postoperative delirium. The association of the composite of death and major complications with postoperative delirium was examined using multivariable logistic regression. Variability in the hospital incidence of postoperative delirium was evaluated using multilevel logistic regression analysis. Among 5 530 054 inpatient admissions for major noncardiac surgery in 3169 hospitals, the mean (SD) patient age was 74.7 (7.0) years, and 3 161 054 admissions (57.2%) were of female patients. The incidence of postoperative delirium was 3.6% (197 921 admissions). Compared with patients without postoperative delirium, patients with postoperative delirium were more likely to experience death or major complications (adjusted OR [aOR], 3.47; 95% CI, 3.41-3.53; P < .001), 30-day mortality (aOR, 2.77; 95% CI, 2.71-2.83; P < .001), and nonhome discharges (aOR, 3.96; 95% CI, 3.88-4.04; P < .001). Controlling for patient characteristics, the odds of postoperative delirium were higher for patients undergoing surgery in hospitals with a higher rate of postoperative delirium compared with hospitals with lower rates of postoperative delirium (median OR, 1.53; 95% CI, 1.50-1.56). In this national retrospective cohort study of more than 5.5 million hospitalizations, older individuals undergoing major noncardiac surgery who experienced postoperative delirium had 3.5-fold higher odds of death or major complications, 2.8-fold higher odds of death, and 4.0-fold higher odds of nonhome discharge. There was substantial variation in the hospital rate of postoperative delirium after accounting for patient risk, which suggests that this complication may be an appropriate target for hospital efforts to improve perioperative brain health, provided that delirium screening and coding accuracy are improved.

Nomogram Model for Predicting Risk of Postoperative Delirium in Adult Liver Transplant Patients: A Retrospective Study

BackgroundPostoperative delirium is a common and serious complication following liver transplantation, early identification of high-risk patients is crucial for implementing preventive strategies and improving clinical outcomes.ObjectiveTo develop and validate a prediction model for postoperative delirium (POD) in adult liver transplant patients using preoperative baseline characteristics, intraoperative factors and postoperative parameters available within 24 hours after surgery. The model aims to assess the risk of POD and provide early identification of high-risk patients.MethodsA retrospective analysis was conducted on liver transplant patients, classified based on the presence or absence of POD. Key risk factors were identified using univariate and multivariate logistic regression. The prediction model was established and validated, with performance evaluated using the area under the receiver operating characteristic curve (AUROC). The prediction model was visualized as a nomogram for practical application.ResultsA total of 480 patients were included, with a POD incidence of 30.8%. Six key predictors were identified: age, APACHE score, albumin, AST, BUN, and blood ammonia. The final model achieved an AUROC of 0.757 (95% CI: 0.709–0.806), sensitivity of 66.2%, and specificity of 77.7%. The optimal classification threshold of the model is 0.341, that is, patients with a predicted probability exceeding 0.341 were classified as high-risk for delirium.ConclusionThe developed nomogram effectively predicts postoperative delirium risk in liver transplant patients, offering clinical utility for risk stratification and management.

Impact of a novel bundled information, education, &amp; communication videos on preoperative anxiety in paediatric patients: A randomised controlled trial

Background &amp; objectives Preoperative anxiety affects 40-75 per cent of children undergoing surgery, leading to postoperative complications. While pharmacological methods have limitations, informational videos have shown promise in reducing anxiety. This pilot study aimed to evaluate the impact of a novel Hindi animated Information, Education, and Communication (IEC) video on preoperative anxiety in Indian children undergoing elective surgeries. The study hypothesised that the video would significantly reduce anxiety scores. Methods A pilot randomised controlled trial was conducted with 30 children aged 5-10 yr scheduled for elective surgeries under general anaesthesia. Participants were randomly assigned to a video intervention group (VI) or a control group (C). Baseline and preoperative anxiety were measured using the Modified Yale Preoperative Anxiety Scale (m-YPAS), Child Fear Scale (CFS), and State-Trait Anxiety Inventory (STAI) for parents. Postoperative emergence delirium and behavioural changes were assessed using the Paediatric Emergence Delirium (PAED) score and Post-Hospitalisation Behaviour Questionnaire (PHBQ). Results Children in the VI group showed significantly lower preoperative anxiety (m-YPAS: 47.9 (10.23) vs. 77.08 (8.38); P&lt;0.001) and heart rates compared to the C group. CFS and STAI-S scores were also significantly lower in the VI group. Although the VI group showed reduced anxiety, there was no significant impact on emergence delirium or postoperative behaviour by day 30. Interpretation &amp; conclusions The Hindi animated IEC video effectively reduced preoperative anxiety in children, highlighting the need for culturally and linguistically appropriate interventions. However, its impact on postoperative outcomes requires further investigation with a larger sample size.

Role of gut microbiota in neuroinflammation: a focus on perioperative neurocognitive disorders

Perioperative neurocognitive disorders (PND), including postoperative delirium, preoperatively cognitive impairment, postoperative cognitive dysfunction, and delayed neurocognitive recovery, represent common complications following anesthesia and surgery, especially in the elderly. As the global population ages, PND is receiving increasing attention due to its prolonged the hospitalization, reduced quality of life and elevated mortality rate. A growing body of evidence has been suggested that the gut-brain axis, a communication system between the gut microbiota and the neuroinflammation, plays a critical role in the development and progression of cognitive impairment. Perioperative interventions, including anesthesia, surgical stress, result in gut microbiota dysbiosis and subsequently trigger neuroinflammation. Therefore, it is necessary to clarify the underlying mechanistic associations between the gut microbiota and the neuroinflammation during PND progression. In this review, we synthesize current knowledge on the mechanistic interplay between gut microbiota dysbiosis and neuroinflammation in PND pathogenesis, which provide reasonable and novel therapeutic approaches targeting the gut-brain axis for PND.

Dose-dependent relationship between intra-operative ketamine administration and postoperative delirium: a retrospective cohort study.

Ketamine is used frequently as an adjunct for general anaesthesia, exerting analgesic and opioid-sparing properties at lower doses and psychotomimetic effects at higher doses. All dose ranges may have effects on the incidence of postoperative delirium, but clinical trials have been equivocal. We hypothesised that intra-operative low-dose ketamine is associated with a lower risk of postoperative delirium. A total of 106,982 adult patients undergoing general anaesthesia for non-cardiac, non-neurosurgical and non-transplant procedures between 2008 and 2024 were included. Primary exposure was the intra-operative cumulative ketamine dose (mg.kg-1 body weight) dichotomised into high vs. low-dose, based on the median of the cohort. Primary outcome was postoperative delirium within 7 days, based on keyword-based search strategy, manual chart review, Confusion Assessment Method recordings and International Classification of Diseases diagnostic codes. Multivariable logistic regression and fractional polynomial regression analyses to assess a potential nonlinear dose-response relationship were performed. Postoperative delirium occurred in 2837 (2.7%) patients. In total, 12,199 (11.4%) patients received ketamine, with a median (IQR [range]) intra-operative dose of 0.35 (0.25-0.52 [0.01-3.86]) mg.kg-1. Compared with patients not receiving ketamine, a low dose (≤ 0.35 mg.kg-1, 6109 patients) was associated with lower risks of postoperative delirium (adjusted odds ratio 0.74 (95%CI 0.59-0.89), adjusted risk difference -0.7% (95%CI -1.0 to -0.3%); p = 0.003). Higher doses of ketamine (> 0.35 mg.kg-1, 6090 patients) did not affect the risk of postoperative delirium (adjusted odds ratio 1.00 (95%CI 0.85-1.18); p = 0.96). Fractional polynomial regression analyses indicated a U-shaped dose-response relationship, with a minimum postoperative delirium risk at a cumulative ketamine dose of 0.25-0.34 mg.kg-1. Intra-operative low-dose ketamine was associated with a lower risk of postoperative delirium, while high doses did not influence the risk.

Analgesic and Neuroprotective Roles of Dexmedetomidine in Spine Surgery: A Systematic Review

Objectives: The incidence of postoperative pain in patients that undergo spinal interventions is significantly increased, affecting their functional outcomes and quality of life. Dexmedetomidine (DEX) belongs to the category of centrally acting nonopioid agents with highly selective α2 adrenoreceptor agonist activity that are frequently applied in spinal surgery based on its antinociceptive and anxiolytic properties. Although many studies displayed the effectiveness of DEX in postoperative pain management, the impact of DEX on functional improvement after spinal surgeries is still debatable. Purpose: This systematic review focuses on the intraoperative and postoperative role of dexmedetomidine (DEX) as an analgesic agent in elective and emergency adult spine surgery. Methods: An electronic literature review search was conducted via Web of Science and PubMed to assess the impact of DEX on postoperative pain management, postoperative delirium (POD), and postoperative cognitive dysfunction (POCD). Discussion: Twenty-one studies were retrieved, three of which were review articles. The effects of DEX were studied for up to 48 h postoperatively. In most cases, its administration was associated with reduced intraoperative and postoperative opioid consumption. However, findings on pain control were less conclusive due to heterogeneity in dosing protocols, concomitant medications, the timing of administration, and pain scoring systems. DEX appears to reduce the incidence of POD and POCD, particularly when used in combination with other drugs. Conclusions: Although the present study supports that the intraoperative administration of dexmedetomidine decreases the pain intensity and/or opioid consumption as well as the development of POD and POCD in patients undergoing spinal surgeries during the first 24 h postoperatively, the current literature should be expanded to allow for the safe generalisation of findings over longer follow-up periods. Further research into the neuroprotective, analgesic, and anti-inflammatory roles of DEX is warranted.

The age‐related susceptibility to postoperative delirium quantified by bispectral electroencephalography correlates with postoperative delirium‐like behavior in mice

AimsPostoperative delirium (POD) is a severe neuropsychiatric state characterized by acute fluctuating various mental symptoms. Despite its prevalence, the underlying mechanisms of POD remain largely unknown, and effective biomarkers for its detection are lacking. We have successfully developed a novel delirium detection method, the bispectral electroencephalography (BSEEG) method, which has shown excellent performance in delirium detection and outcome prediction. From there, like the clinical situation, we hypothesize that BSEEG scores can serve as indicators of POD‐like states in mice. This study investigated the correlation between POD‐like behavior and BSEEG score in a mouse model following EEG head‐mount implantation surgery.MethodsFirst, 2–3‐ and 22–23‐month‐old male C57BL/6J mice underwent EEG head‐mount implantation surgery, followed by EEG monitoring and a battery of behavioral tests, including the buried food test, the open field test, and the Y‐maze, to assess POD‐like behavior. We measured BSEEG scores and analyzed the correlation between these scores and the behavior measurements.ResultsThe results showed BSEEG scores correlated with attention deficit and decreases in locomotor activity in young mice, whilst BSEEG scores only correlated with a decrease in locomotor activity in aged mice. Notably, composite Z scores representing delirium severity also showed a correlation with BSEEG scores in young mice.ConclusionOur findings indicate that the BSEEG method can be an indicator of POD‐like states consistent with those measured by behavior tests. This study provides a novel preclinical framework for understanding the pathophysiology of POD and underscores the potential of BSEEG as a valuable tool for delirium detection and severity assessment.

Risk factors for general complications after hip or knee replacement surgery in elderly patients: a single-center study

PurposeTo determine the risk factors for complications after hip or knee replacement surgery in elderly patients.MethodsIn total, 401 elderly patients (aged ≥ 65 years) who underwent hip or knee replacement surgery at a hospital from January 2017 to December 2022 were retrospectively analyzed. Univariate analysis was performed to identify significant variables. Risk factors and the effects of the model were examined by unconditional binary logistic regression analyses and receiver operating characteristic (ROC) curve analysis, respectively.ResultsA total of 122 (30.42%) patients were diagnosed with complications after hip or knee replacement surgery, and the independent risk factors for complications were age, body mass index (BMI) and hypertension. Fifty-six patients (13.97%) developed lower extremity venous thrombosis (LEVT), and the independent risk factors were hypertension, surgical joint type and visual analog scale (VAS) pain score. Cardiopulmonary complications occurred in 50 patients (12.47%), and the independent risk factors were age and BMI. Postoperative delirium occurred in 15 patients (3.74%), and its independent risk factors were age and American Society of Anesthesiologists (ASA) grade. Two or more complications occurred in 17 patients (4.24%), and the independent risk factors were age and diabetes.ConclusionsThis study focused on elderly patients with risk factors for complications after hip or knee replacement surgery. Clinically, elderly patients undergoing hip or knee replacement surgery should perform well in terms of preoperative and perioperative management.

Development and validation of a nomogram model for predicting postoperative delirium in elderly patients with oral cancer: a retrospective study

ObjectiveThis study aimed to develop and internally validate a dynamic a nomogram model by analysing the risk factors for postoperative delirium (POD) in elderly patients with oral cancer.MethodsThis was a single-centre, retrospective study. We used the convenience sampling method to select 359 elderly oral cancer patients from January 2020-August 2023 in Nanjing Stomatological Hospital. The original dataset was randomly divided into a training group (n = 252) and a validation group (n = 107) by a computer-generated random number sequence in a 7:3 ratio. Least Absolute Shrinkage and Selection Operator Regression (LASSO regression) were used to screen the best predictor variables. Logistic regression was used to build the model and visualized by nomogram. The performance of the model was evaluated by area under the curve (AUC), calibration curve and decision curve analysis (DCA).ResultsOur predictive model showed that seven variables, age, sex, alcohol consumption history, marriage, preoperative anxiety, preoperative sleep disorder, and ICU length of stay, were associated with POD. The nomogram showed high predictive accuracy with an AUC of 0.82 (95% CI: 0.76–0.87) for the training group and 0.84 (95% CI: 0.76–0.92) for the internal validation group. In two groups, there was good agreement between the predicted results and the true observations. DCA showed that the predictive model had a good net clinical benefit.ConclusionWe developed a new predictive model to predict risk factors for POD in elderly oral cancer patients. The nomogram can help physicians assess POD quickly and effectively.

Development and validation of a prediction model for postoperative delirium in older patients undergoing major noncardiac surgery: protocol for a prospective multi-centre cohort study

BackgroundPostoperative delirium (POD) is a common complication in older patients after surgery, leading to a series of adverse outcomes. This study aims to develop and validate a prediction model for POD in older patients following major noncardiac surgery.MethodsIn this prospective, multi-centre, cohort study, a total of 972 older patients undergoing major noncardiac surgery will be enrolled from three hospitals in Jiangsu, China (n = 680 for model development and n = 292 for external validation). Candidate predictors have been selected according to existing literature and clinical expertise. The primary outcome is POD within 7 days postoperatively or before discharge, assessed by the 3-minute Confusion Assessment Method or Confusion Assessment Method for Intensive Care Unit. The secondary outcomes include postoperative pain intensity, quality of recovery, and quality of sleep. The model will be derived using the univariate and multivariable logistic regression analyses. The internal validation will be conducted using the bootstrapping method. Based on data from different study sites, the external validation will be performed using the area under the receiver operating characteristic curve, Hosmer-Lemeshow goodness-of-fit statistic, and max-rescaled Brier score.DiscussionThe results of this multi-centre cohort study will be presented as the model formula and a web-based risk calculator for clinical application, contributing to early prediction of POD and improvement of decision-making in older patients undergoing major noncardiac surgery.Trial registrationChinese Clinical Trial Register (ID: ChiCTR2300072164, https://www.chictr.org.cn/showprojEN.html?proj=197451. ), prospectively registered on 5 June 2023.

Surgery May Be a Major Contributor for Postoperative Delirium in Patients With Elective Thoracic Aortic Aneurysm Procedures.

Postoperative delirium (POD) is relatively common and is associated with poor outcomes. Age is a risk factor for POD. This single-center observational study is designed to determine whether surgery is a major contributor to the development of POD and inflammatory response. Patients with elective procedures to repair thoracic aortic aneurysm were recruited to the study. Confusion Assessment Method was used to assess POD. Their blood and cerebrospinal fluids were harvested for analysis of inflammatory and neuronal injury indicators. A total of 67 patients were included in this study: 32 had stent placement under general anesthesia and 35 had open surgery to repair the aneurysm. No patients in the stent placement group had POD, but 9 patients in the open surgery group had POD (25.7%). Patients with POD had a lower body temperature at the end of surgery than patients without POD [36.3°C (35.7°C-36.6°C) vs. 36.7°C (36.3°C-37.0°C), p = 0.046]. This parameter was identified as a risk factor for POD. Patients in the open surgery group had increased interleukin 1β and neurofilament light chain in the blood. However, there was no change in these biomarkers in the cerebrospinal fluids at 10 and 24 h after surgery. Our results suggest that surgery is a major contributor to POD, inflammatory response, and neuronal injury. Low body temperature at the end of surgery is a potential risk factor for POD in patients with open repair for thoracic aortic aneurysm.