Postoperative Delirium

The aim of this study was to evaluate the safety and efficacy of the early administration haloperidol in preventing the aggravation of postoperative delirium in elderly patients. A total of 201 patients (age ≥75years) who underwent elective surgery were enrolled. The patients were divided into two groups: the intervention group (n=101) received prophylactic haloperidol (5mg); the control group (n=100) did not. Haloperidol was administered daily during postoperative days 0-5 to the patients who presented with NEECHAM scores of 20-24 when measured at 18:00. The primary endpoint was the incidence of severe postoperative delirium. The incidence of severe postoperative delirium in all patients was 25.1%. The incidence of severe postoperative delirium in the intervention group (18.2%) was significantly lower than that in the control group (32.0%) (p=0.02). The difference between the two groups was larger when the analysis was limited to the 70 patients who had NEECHAM scores of 20-24 for at least one day during postoperative days 0-5. No adverse effects of the haloperidol were observed. The prophylactic administration of haloperidol at the early stage of delirium significantly reduced the incidence of severe postoperative delirium in elderly patients. Clinical Trial Registration UMIN000007204.

BackgroundThe postoperative delirium is a common yet serious complication in elderly patients with hip fracture. We aimed to evaluate the potential risk factors of delirium in patients with hip fracture, to provide reliable evidence to the clinical management of hip fracture.MethodsThis study was a retrospective design. Elderly patients who underwent hip fracture surgery in our hospital from June 1, 2019 to December 30, 2020 were selected. The characteristics and treatment data of delirium and no delirium patients were collected and compared. Multivariate logistic regression analysis was performed to analyze the influencing factors affecting postoperative delirium in elderly patients with hip fracture.ResultsA total of 245 patients with hip fracture were included, the incidence of postoperative delirium in patients with hip fracture was 13.06%. There were significant differences in the age, BMI, history of delirium, estimated blood loss and duration of surgery (all p < 0.05). There were significant differences in the albumin and TSH between delirium and no delirium group (all p < 0.05), Logistics analyses indicated that age ≥ 75 years (OR 3.112, 95% CI 1.527–5.742), BMI ≥ 24 kg/m2 (OR 2.127, 95% CI 1.144–3.598), history of delirium (OR 1.754, 95% CI 1.173–2.347), estimated blood loss ≥ 400 mL (OR 1.698, 95% CI 1.427–1.946), duration of surgery ≥ 120 min (OR 2.138, 95% CI 1.126–3.085), preoperative albumin ≤ 40 g/L (OR 1.845, 95% CI 1.102–2.835) and TSH ≤ 2 mU/L (OR 2.226, 95% CI 1.329–4.011) were the independent risk factors of postoperative delirium in patients with hip fracture(all p < 0.05).ConclusionsPostoperative delirium is very common in elderly patients with hip fracture, and it is associated with many risk factors, clinical preventions targeted on those risk factors are needed to reduce the postoperative delirium.

The aim of this prospective study was to determine incidence, duration, and risk factors for postoperative delirium (PD) in elderly patients undergoing major abdominal surgery. The incidence and risk factors of PD after major abdominal surgery in elderly patients are not well documented. From May 2006 to May 2008, 118 patients aged 75 years or more without severe preoperative cognitive dysfunction (mini mental state examination score >10/30) and undergoing major elective abdominal surgery were included. The preoperative geriatric assessment battery consisted of 4 tests evaluating physical (instrumental activities of daily living and timed get up and go test score) and cognitive function (mini mental state examination score), and detecting the presence of an underlying depression (Short-GDS). After the operation, geriatric patients were assessed for PD by the Confusion Assessment Method. Univariate and multivariate analyses were used to determine risk factors for PD. Overall, PD occurred in 28 patients (24%). Multivariate analysis showed that an American Society of Anesthesiologists status of 3-4 (P = 0.02), impaired mobility (timed get up and go test score >20 seconds) (P = 0.009) and postoperative tramadol administration (P = 0.0009) were risk factors for PD. The mortality rate was 14% in 28 patients with PD and 3.3% in 90 patients without PD (P = 0.051). The morbidity rate was 35.5% in 28 patients with PD and 32% in 90 patients without PD (NS). The mean hospital stay was 19 +/- 11 days for patients with PD and 14 +/- 8 for patients without PD (P = 0.01). Fifteen of 24 (62.5%) surviving patients with PD and 28 of 87 (32%) surviving patients without PD were discharged to geriatric rehabilitation unit (P = 0.007). PD is a frequent and severe postoperative event in elderly patients after major abdominal surgery. A perioperative geriatric assessment should be recommended to patients with an American Society of Anesthesiologists status of 3-4 and preoperative impaired mobility to facilitate the management of PD. In these patients, the postoperative administration of tramadol should be avoided.

BackgroundPostoperative delirium (POD) is one of the most prevalent complications in elderly surgical patients. This study aimed to assess whether the use of transversus abdominis plane block (TAPB) is associated with a reduced incidence of POD in this patient population.MethodsIn this retrospective cohort study (January 2016 to March 2022), we analyzed elderly patients (≥ 65 years) who underwent major gastrointestinal surgery. The association between TAPB and POD was evaluated using multivariate logistic regression, propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and subgroup analyses.ResultsAmong 5,220 patients, the incidence of POD was significantly lower in patients receiving TAPB. This protective effect was consistently demonstrated in Multivariate regression analysis, OR was 0.351 (95% CI 0.163 to 0.663, P = 0.003). Consistent findings emerged after PSM (P = 0.007) and IPTW (P < 0.001) adjustment. TAPB was also associated with significantly reduced sufentanil requirements (P < 0.001) and shorter hospital length of stay (P < 0.001). However, 30-day postoperative mortality did not differ significantly between groups. Subgroup analyses stratified by age, sex, albumin, surgical site, Body mass index (BMI), and dexmedetomidine demonstrated no significant interaction effects across all variables (P-interaction > 0.05).ConclusionsCurrent evidence suggests that the use of TAPB is significantly associated with a reduced incidence of POD in elderly patients undergoing major gastrointestinal surgery.Trial registrationThe trial was registered on ClinicalTrials.gov on February 14, 2025, with the identifier NCT06829108Supplementary InformationThe online version contains supplementary material available at 10.1186/s12871-025-03363-w.

Psychiatric management of Patients in intensive care units.

The reported incidence of postoperative delirium (POD) in elderly patients ranges from 6 to 53 %. Several preoperative and operative factors have been reported as risk factors of POD. The aim of this study was to determine the incidence of and risk factors for POD in patients with colorectal cancer who had undergone laparoscopic colorectal resection. A total of 311 consecutive patients aged 75 years and older who underwent laparoscopic surgery for colorectal cancer at our department from January 2008 to December 2013 were classified as delirious group (n = 44) and nondelirious group (n = 267). Short-term outcomes and risk factors for POD were analyzed. POD was diagnosed in 14.1 % of elderly patients with colorectal cancer. Univariate analysis showed that older age, high American Society of Anesthesiology (ASA) score, performance status >2, low prognostic nutrition index (PNI), past history of delirium or dementia, operative approach, Organ/Space SSI, and cardiac or pulmonary disease were significantly associated with POD. Multivariate logistic regression analysis identified older age, past history of delirium or dementia, operative approach, and Organ/Space SSI as four independent risk factors for POD. Our results suggest that the risk of POD is associated with older age, past history of delirium or dementia, operative approach, Organ/Space SSI.

BackgroundCritical limb ischemia has been identified as a risk factor for the incidence of postoperative delirium in elderly patients. Limb amputation is the last option in critical limb ischemia treatments. We investigated the incidence and predisposing factors of postoperative delirium in patients undergoing major leg amputation.MethodsFrom January 2012 to December 2016, 121 patients aged over 60 years who had undergone major leg amputation were enrolled in this study. Various factors related to the patients’ outcomes were assessed, including demographic, preoperative laboratory, anesthetic, surgical, and postoperative indicators.ResultsTwenty two patients were excluded and 99 patients were assigned to either the delirium group or no delirium group. Forty of them (40%) developed a delirium during 30 days postoperatively. Univariate analysis implied that end-stage renal disease on hemodialysis, alcohol consumption, C-reactive protein, staying in an intensive care unit (ICU), duration of an ICU stay, occurrence of complications, and mortality during six months, were the factors that accounted for significant differences between the two groups. In multivariate analysis, three factors were significantly related to the development of delirium: mortality during six months (odds ratio [OR] = 13.86, 95% CI [2.10–31.90]), alcohol (OR = 8.18, 95% CI [1.13–16.60]), and hemodialysis (OR = 4.34, 95% CI [2.06–93.08]).ConclusionsApproximately 40% of the elderly patients suffered from postoperative delirium in major leg amputation. Identifying those with risk factors for postoperative delirium and intervening at the early stage will be of great benefit in major leg amputations for the elderly population.

Melatonin for Treatment and Prevention of Postoperative Delirium

Postoperative delirium (POD) has been confirmed as an important complication after major surgery. However, neurosurgical patients have usually been excluded in previous studies. To date, data on POD and risk factors in patients after intracranial surgery are scarce. To determine the incidence and risk factors of POD in patients after intracranial surgery. Prospective cohort study. A neurosurgical ICU of a university-affiliated hospital, Beijing, China. Adult patients admitted to the ICU after elective intracranial surgery under general anaesthesia were consecutively enrolled between 1 March 2017 and 2 February 2018. Delirium was assessed using the Confusion Assessment Method for the ICU. POD was diagnosed as Confusion Assessment Method for the ICU positive on either postoperative day 1 or day 3. Patients were classified into groups with or without POD. Data were collected for univariate and multivariate analyses to determine the risk factors for POD. A total of 800 patients were included. POD was diagnosed in 157 patients (19.6%, 95% confidence interval 16.9 to 22.4%). Independent risk factors for POD included age, nature of intracranial lesion, frontal approach craniotomy, duration of surgery, presence of an episode of low pulse oxygenation at ICU admission, presence of inadequate emergence and emergence delirium, postoperative pain and presence of immobilising events. POD was associated with adverse outcomes and high costs. POD is prevalent in patients after elective intracranial surgery. The identified risk factors for and the potential association of POD with adverse outcomes suggest that a comprehensive strategy involving screening for predisposing factors and early prevention of modifiable factors should be established in this population. ClinicalTrials.gov NCT03087838.

Delirium is a common complication in elderly hospitalized patients. It prolongs the length of hospital stay, raises costs, increases the workload of the nursing staff, and may necessitate transfer of the patient to a nursing home. The risk of postoperative delirium is particularly high in elderly patients with pre-existing cognitive deficits. In an open study, we systematically assessed the frequency of postoperative delirium in patients over age 70 on two surgical wards of a general hospital. In a six-month "prevalence phase," from March to August 2011, we counted the number of patients with postoperative delirium, but did not initiate any intervention. Thereafter, in a ten-month "intervention phase" from September 2011 to June 2012, a nurse with special training in the management of delirium carried out an intervention involving component measures of the Hospital Elder Life Program (HELP) on one of the two wards, with the aim of preventing postoperative delirium. The patients on the other ward served as a control group. In the prevalence phase, 20.2% of all patients developed postoperative delirium (95% confidence interval [CI], 14.6-26.4). In the intervention phase, postoperative delirium arose in 20.8% (95% CI, 11.3-32.1) of the patients on the ward with no specific interventions, but in only 4.9% (95% CI, 0.0-11.5) of those on the ward where the intervention was carried out. The difference was presumably due to the measures initiated by the specially trained nurse, including validation, improvement of sleep, cognitive activation, early mobilization, improved sensory stimulation, and improved nutritional and fluid intake. Important predictors of postoperative delirium included a low score on the Mini-Mental State Examination, advanced age, and preoperative infection. The frequency of postoperative delirium in elderly patients with cognitive deficits can be lowered with nursing measures carried out by a specially trained nurse, close postoperative supervision, and cognitive activation.

Postoperative delirium (POD) significantly impacts patient outcomes after acute type A aortic dissection (ATAAD) surgeries. This study investigates the role of Neuronal Pentraxin 2 (NPTX2) as a potential biomarker for POD in ATAAD patients. This secondary analysis involved ATAAD patients from a prospective observational study. Serum NPTX2 levels were measured preoperatively and immediately postoperatively using Enzyme-Linked Immunosorbent Assay (ELISA). Delirium was assessed using the Confusion Assessment Method (CAM) or CAM for the ICU (CAM-ICU). Statistical analyses included the Pearson Correlation Coefficient and multivariate logistic regression to evaluate the association between NPTX2 levels and POD. Among the 62 patients included, 46.77% developed POD. Patients with POD had significantly lower preoperative and postoperative serum NPTX2 levels. The Receiver Operating Characteristic (ROC) curve analysis showed that postoperative NPTX2 had a strong predictive capability for POD (AUC = 0.895). The optimal cutoff for postoperative NPTX2 in predicting POD was less than 421.4 pg/mL. Preoperative NPTX2 also demonstrated predictive value, albeit weaker (AUC = 0.683). Serum NPTX2 levels, both preoperatively and postoperatively, are promising biomarkers for predicting POD in ATAAD patients. These findings suggest that NPTX2 could be instrumental in early POD detection and intervention strategies.

Delirium is one of the most common and serious complications after cardiac surgery with cardiopulmonary bypass (CPB). A comprehensive assessment of independent risk factors for postoperative delirium (POD) is essential for early detection and prevention. To investigate the incidence and independent associated factors of POD in adults undergoing cardiac surgery with CPB. Prospective cohort design. A total of 203 patients were enrolled in this study from October 2022 to December 2023 in China. Richmond agitation and sedation scale (RASS) and confusion assessment method-intensive care unit (CAM-ICU) were used for assessing delirium symptom. This study analysed various factors for POD, including demographic, physical, psychological, social, spiritual and environmental aspects. Using logistic regression analysis to identify the independent associated factors. A totla of 60.1% (n = 122) of patients had POD. Of these cases, 86 (70.5%) were hypoactive delirium, 4 (3.3%) were hyperactive delirium and 32 (26.2%) were mixed delirium. Advanced age (OR = 1.069, 95% confidence interval [CI]: 1.031-1.107; p < 0.001), preoperative depression (OR = 1.847, 95% CI: 1.246-2.736; p = 0.002), postoperative albumin level (OR = 0.921, 95% CI: 0.851-0.997; p = 0.042) and duration of mechanical ventilation (OR > 1.000, 95% CI: 1.000-1.001; p < 0.001) were independent predictors of POD. The incidence of POD in patients undergoing cardiac surgery with CPB was high. This study identified advanced age, preoperative depression, postoperative albumin level and duration of mechanical ventilation as significant and independent predictors of POD. The study's findings highlight the urgent necessity for improved clinical vigilance and proactive management strategies. No patient or public contribution.

Analyze the risk factors for postoperative delirium (POD) in elderly patients undergoing radical prostatectomy, and built a predictive nomogram model for early identification of high-risk individuals. A total of 156 patients was recruited and categorized based on whether the development of POD within 7days post-surgery. After identifying independent risk factors through univariate and multivariate logistic regression analyses, predictive models were established. The discrimination and calibration were determined by C-index and calibration curve, with five-fold cross-validation executed. A nomogram model representing the optimal model was constructed based on the results. POD occurred in 24 (15.38%) patients. Significant differences were observed in age, anxiety, physical status, sleep disorders, blood glucose, age-adjusted Charlson comorbidity index (ACCI), anticholinergic, blood loss, postoperative infection, and postoperative pain assessed by the numerical rating scale (NRS). Logistic regression analyses showed that sleep disorders (OR:12.931, 95% CI:1.191-140.351, P = 0.035), ACCI (OR:2.608, 95% CI:1.143-5.950, P = 0.023), postoperative infection (OR:19.298, 95% CI:2.53-147.202, P = 0.04), and NRS (OR:4.033, 95% CI:1.062-15.324, P = 0.041) were independent risk factors for POD. Model 1 (postoperative infection, ACCI, preoperative sleep disorder, NRS)showed better diagnostic performance than the others, of which the area under the curve (AUC) was 0.973. The best diagnostic performance was found in model 1 through five-fold cross-validation, with a C-index of 0.963. This prospective cohort study highlighted that ACCI, preoperative sleep disorder, postoperative pain, and postoperative infection were identified as independent risk factors for POD. Furthermore, the nomogram derived from model 1 proved to be effective in predicting POD in elderly patients undergoing radical prostatectomy.

To systematically evaluate the risk factors associated with postoperative delirium (POD) in patients receiving routine care in the post-anesthesia care unit (PACU). Relevant literature concerning risk factors for POD in PACU patients was retrieved from CNKI, Wanfang, and VIP databases from inception up to August 2025. Three researchers independently completed literature screening, data extraction, quality evaluation, and evidence grading. Meta-analysis was performed using RevMan 5.3 software, and publication bias was assessed using Begg's test in Stata 18.0. A total of 20 case-control studies involving 6,877 patients were included. Meta-analysis showed that risk factors for POD in PACU patients included: gender (OR = 1.17, 95%CI:1.03-1.33, P = 0.02), age (SMD = 2.05, 95%CI:1.52-2.57, P < 0.00001), prolonged operation time (SMD = 1.02, 95%CI:0.44-1.60, P = 0.0006), low BMI (SMD = -0.29, 95%CI:-0.53-0.04, P = 0.02), prolonged anesthesia time (SMD = 1.58, 95%CI:0.88-2.88, P < 0.00001), hypertension (OR = 1.27, 95%CI:1.06-1.51, P = 0.009), diabetes mellitus (OR = 1.44, 95%CI:1.01-2.06, P = 0.04), smoking (OR = 1.38, 95%CI:1.11-1.71, P = 0.004), decreased hemoglobin level (SMD = -1.05, 95%CI: -3.97-0.12, P = 0.04), alcohol consumption (OR = 1.33, 95%CI:1.05-1.63, P = 0.02), increased intraoperative blood loss (SMD = 3.74, 95%CI:1.60-5.87, P = 0.0006), higher American Society of Anesthesiologists (ASA) physical status classification (OR = 0.66, 95%CI:0.47-0.92, P = 0.02), insufficient use of dexmedetomidine (OR = 0.33, 95%CI:0.23-0.52, P < 0.00001), prolonged hospital stay (SMD = 2.01, 95%CI:0.76-3.27, P = 0.002), low educational level (OR = 1.43, 95%CI:1.03-1.98, P = 0.03), history of cerebral infarction (OR = 2.31, 95%CI:1.48-3.60, P = 0.0002), and decreased postoperative albumin level (SMD = -1.91, 95%CI: -2.76-1.07, P < 0.00001). Multiple demographic, perioperative, and disease-related factors are associated with the occurrence of POD in PACU patients under routine care. This study provides an evidence-based reference for the early identification and prevention of POD. The clinical value of these risk factors as an intervention still needs to be verified by high-quality prospective studies. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261341102, identifier: CRD420261341102.

Background and Aims:Delirium is defined as an acute disturbance in consciousness along with impaired thought processing and easy distraction. Buprenorphine is a mixed agonist–antagonist opioid analgesic. Few case reports have been published about the possible association between buprenorphine and delirium. The aim of this study was to look for an association between buprenorphine and postoperative delirium in patients undergoing off-pump coronary artery bypass grafting (CABG) surgery.Methods:Retrospective data from 100 cases of off-pump CABG were collected. The patients were divided into two groups (50 patients each). In group I, buprenorphine was used for postoperative analgesia. In group II, buprenorphine was not used for postoperative analgesia.Results:On post-operative day 0, there was no incidence of delirium in both groups. On post-operative days two and three, there was no incidence of delirium in group II, but a statistically significant incidence of delirium was seen in group I (P = 0.012, relative risk >1). The overall (all four days) incidence of delirium was higher in group I which was statistically significant (P = 0.006). The total number of delirium cases was seven (14%) in group I and out of the seven delirium cases, five patients (10%) had hyperactive delirium, and two patients (4%) had hypoactive delirium.Conclusion:Use of buprenorphine was associated with post-operative delirium, particularly of the hyperactive motoric subtype in off-pump CABG patients.