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Postoperative delirium has the potential to impact individuals of all age groups, with a significant emphasis on the elderly population. Its presence leads to an increase in surgical morbidity and mortality rates, as well as a notable prolongation of hospital stays. However, there is a lack of research regarding the prevalence, risk factors, and implications of postoperative delirium in developing nations like Ethiopia, which affects both patients and healthcare institutions. An observational study was conducted at hospitals in the South Gondar Zone to diagnose postoperative delirium in the Post-Anesthesia Care Unit (PACU) using the Nursing Delirium Screening Scale. Both bivariable and multivariable logistic regression techniques were employed to analyze the association between independent factors and postoperative delirium. The strength of the association was indicated by the odds ratio with a 95% confidence interval (CI). Any p-values below 0.05 were considered statistically significant. The incidence of postoperative delirium was determined to be 41%. In the multivariate logistic regression analysis, several factors were identified as significantly associated with postoperative delirium. These factors include an age of 75 or older (AOR, 11.24; 95% CI, 4.74–26.65), ASA-PS IV (AOR, 3.25; 95% CI, 1.81–5.85), severe functional impairment of activities of daily living (AOR, 3.29; 95% CI, 1.06–10.20), premedication with benzodiazepine (AOR, 4.61; 95% CI, 2.48–8.57), intraoperative estimated blood loss exceeding 1000 ml (AOR, 2.74; 95% CI, 1.50–4.98), and intraoperative ketamine use (AOR, 3.84; 95% CI, 2.21–6.68). Additionally, postoperative delirium was found to significantly prolong the duration of stay in the post-anesthesia care unit (PACU) and the length of hospital stay (p-value < 0.05). Patients aged 75 or older, ASA-PS IV, experiencing severe functional impairment of ADL, patients premedicated with benzodiazepine, patients with intraoperative estimated blood loss exceeding 1000 ml, and intraoperative ketamine use were identified as risk factors for post-operative delirium.

Postoperative delirium (POD) is a common and serious complication after surgery. Various predisposing factors are associated with POD, but their magnitude and importance using an individual patient data (IPD) meta-analysis have not been assessed. To identify perioperative factors associated with POD and assess their relative prognostic value among adults undergoing noncardiac surgery. MEDLINE, EMBASE, and CINAHL from inception to May 2020. Studies were included that (1) enrolled adult patients undergoing noncardiac surgery, (2) assessed perioperative risk factors for POD, and (3) measured the incidence of delirium (measured using a validated approach). Data were analyzed in 2020. Individual patient data were pooled from 21 studies and 1-stage meta-analysis was performed using multilevel mixed-effects logistic regression after a multivariable imputation via chained equations model to impute missing data. The end point of interest was POD diagnosed up to 10 days after a procedure. A wide range of perioperative risk factors was considered as potentially associated with POD. A total of 192 studies met the eligibility criteria, and IPD were acquired from 21 studies that enrolled 8382 patients. Almost 1 in 5 patients developed POD (18%), and an increased risk of POD was associated with American Society of Anesthesiologists (ASA) status 4 (odds ratio [OR], 2.43; 95% CI, 1.42-4.14), older age (OR for 65-85 years, 2.67; 95% CI, 2.16-3.29; OR for >85 years, 6.24; 95% CI, 4.65-8.37), low body mass index (OR for body mass index <18.5, 2.25; 95% CI, 1.64-3.09), history of delirium (OR, 3.9; 95% CI, 2.69-5.66), preoperative cognitive impairment (OR, 3.99; 95% CI, 2.94-5.43), and preoperative C-reactive protein levels (OR for 5-10 mg/dL, 2.35; 95% CI, 1.59-3.50; OR for >10 mg/dL, 3.56; 95% CI, 2.46-5.17). Completing a college degree or higher was associated with a decreased likelihood of developing POD (OR 0.45; 95% CI, 0.28-0.72). In this systematic review and meta-analysis of individual patient data, several important factors associated with POD were found that may help identify patients at high risk and may have utility in clinical practice to inform patients and caregivers about the expected risk of developing delirium after surgery. Future studies should explore strategies to reduce delirium after surgery.

Postoperative delirium (POD) is a serious complication of surgery, especially in the elderly patient population. It has been proposed that decreasing the amount of anesthetics by titrating to an EEG index will lower POD rate, but clear evidence is missing. A strong age-dependent negative correlation has been reported between the peak oscillatory frequency of alpha waves and end-tidal anesthetic concentration, with older patients generating slower alpha frequencies. We hypothesized, that slower alpha oscillations are associated with a higher rate of POD. Retrospective analysis of patients` data from a prospective observational study in cardiac surgical patients approved by the Bernese Ethics committee. Frontal EEG was recorded during Isoflurane effect-site concentrations of 0.7 to 0.8 and peak alpha frequency was measured at highest power between 6 and 17 Hz. Delirium was assessed by chart review. Demographic and clinical characteristics were compared between POD and non-POD groups. Selection bias was addressed using nearest neighbor propensity score matching (PSM) for best balance. This incorporated 18 variables, whereas patients with missing variable information or without an alpha oscillation were excluded. Of the 1072 patients in the original study, 828 were included, 73 with POD, 755 without. PSM allowed 328 patients into the final analysis, 67 with, 261 without POD. Before PSM, 8 variables were significantly different between POD and non-POD groups, none thereafter. Mean peak alpha frequency was significantly lower in the POD in contrast to non-POD group before and after matching (7.9 vs 8.9 Hz, 7.9 vs 8.8 Hz respectively, SD 1.3, p < 0.001). Intraoperative slower frontal peak alpha frequency is independently associated with POD after cardiac surgery and may be a simple intraoperative neurophysiological marker of a vulnerable brain for POD. Further studies are needed to investigate if there is a causal link between alpha frequency and POD. •Delirium remains a serious postoperative complication, that is difficult to treat and predict.•Negative correlation of frontal alpha frequency and end-tidal anesthetic exists.•Low frontal alpha frequency serves as a predictor for postoperative delirium.•Anesthetic titration on alpha frequency might help reduce postoperative delirium.

Postoperative delirium is common in older adult patients and associated with a poor prognosis. The use of benzodiazepine was identified as an independent risk factor for delirium, but there is no randomized controlled trial regarding the relationship between remimazolam, a new ultra-short acting benzodiazepine, and postoperative delirium. We designed a randomized controlled trial to evaluate if remimazolam increases the incidence of postoperative delirium compared with propofol in older adult patients undergoing orthopedic surgery with general anesthesia. We enrolled 320 patients aged more than 60 with American Society of Anesthesiologists physical status I-III who underwent orthopedic surgery. Patients were randomized to two groups to receive intraoperative remimazolam or propofol, respectively. Our primary outcome was the incidence of delirium within 3 days after surgery. Secondary outcome was emergence quality including the incidence of emergence agitation, extubation time, and length of post-anesthesia care unit (PACU) stay. Adverse events were also recorded. The incidence of postoperative delirium was 15.6% in the remimazolam group and 12.4% in the propofol group (Risk ratio, 1.26; 95% CI, 0.72 to 2.21; Risk difference, 3.2%; 95% CI, -4.7% to 11.2%; P = 0.42). No significant differences were observed for time of delirium onset, duration of delirium, and delirium subtype between the two groups. Patients in remimazolam group had a lower incidence of hypotension after induction and consumed less vasoactive drugs intraoperatively, but had a longer postoperative extubation time and PACU stay. General anesthesia with remimazolam was not associated with an increased incidence of postoperative delirium compared with propofol in older adult patients undergoing orthopedic surgery.

This study aims to evaluate the effects of preoperative low-dose dexmedetomidine administration for one night on the incidence of postoperative delirium in elderly patients with hip fracture. This was a randomized, double blind, placebo-controlled clinical trial. Lu'an Hospital of Anhui Medical University, Anhui, China. Patients aged ≥65 years with hip fracture (femoral neck, intertrochanteric, or subtrochanteric fracture) and scheduled for surgical repair(total hip arthroplasty, hemiarthroplasty, internal fixation with cannulated screw or intramedullary nail) under spinal anesthesia were eligible. Patients were randomized 1:1 to receive low-dose dexmedetomidine or placebo from 8:00 pm before surgery to 8:00 am the day of surgery. The primary outcome was the incidence of POD between postoperative days 1 and 7 or at hospital discharge. The secondary outcome measures included preoperative sleep quality, days of delirium, visual analog scale scores in quiet and active states on postoperative days 1–3, C-reactive protein level, number of analgesic pump presses, activities of daily living score at discharge and postoperative hospital stay. Perioperative adverse events were recorded. Of the 248 patients randomized to the placebo (n = 124) or dexmedetomidine (n = 124) group, 233 participants (117 in the placebo group and 116 in the dexmedetomidine group) were included in the modified intention-to-treat analysis. The incidence of POD was lower in the dexmedetomidine group (10.3 %) than placebo group (22.2 %, P = 0.014). Compared to the placebo group, the dexmedetomidine group had higher preoperative Leeds Sleep Evaluation Questionnaire (LSEQ) scores (P < 0.001), lower preoperative Insomnia Severity Index (ISI) scores (P < 0.001), and lower postoperative C-reactive protein (CRP) levels (P < 0.001). No differences in other secondary outcomes and perioperative adverse events were observed between the two groups. In patients aged ≥65 years undergoing elective hip fracture surgery under spinal anesthesia, continuous overnight administration of low-dose dexmedetomidine improved sleep quality on the night before surgery and reduced the incidence of POD. •There are currently no interventions to effectively reduce postoperative delirium in old patients with hip fracture.•The incidence of preoperative sleep disorders is high in elderly patients with hip fractures.•Low-dose dexmedetomidine given the night before surgery reduced postoperative delirium and improved sleep quality in patients.•The results offer a new perspective for future delirium prevention.

Early post-operative delirium is a common perioperative complication in the post anesthesia care unit. To date it is unknown if a specific anesthetic regime can affect the incidence of delirium after surgery. Our objective was to examine the effect of volatile anesthetics on post-operative delirium. Single Center Observational Study. Post Anesthesia Care Units at a German tertiary medical center. 30,075 patients receiving general anesthesia for surgery. Delirium was assessed with the Nursing Delirium Screening Scale at the end of the recovery period. Subgroup-specific effects of volatile anesthetics on post-operative delirium were estimated using generalized-linear-model trees with inverse probability of treatment weighting. We further assessed the age-specific effect of volatiles using logistic regression models. Out of 30,075 records, 956 patients (3.2%) developed delirium in the post anesthesia care unit. On average, patients who developed delirium were older than patients without delirium. We found volatile anesthetics to increase the risk (Odds exp. (B) for delirium in the elderly 1.8-fold compared to total intravenous anesthesia. Odds increases with unplanned surgery 3.0-fold. In the very old (87 years or older), the increase in delirium is 6.2-fold. This result was confirmed with internal validation and in a logistic regression model. Our exploratory study indicates that early postoperative delirium is associated with the use of volatile anesthetics especially in the sub-cohort of patients aged 75 years and above. Further studies should include both volatile and intravenous anesthetics to find the ideal anesthetic in elderly patients. •Early post-operative delirium is a common perioperative complication.•Though many risk factors are known, the ideal anesthetic regime is unknown.•In a big data approach, the association of volatiles with delirium was examined.•Use of volatile anesthetics in the very old is associated with delirium.

Background: Delirium after surgery is a spectrum of clinical syndrome constituting emergence delirium (ED) and/or postoperative delirium (POD). Objectives: The primary objective of this study was to evaluate the incidence of ED and POD in patients after neurosurgical procedures. The secondary objectives were to examine the relationship between ED and POD and identify perioperative risk factors of ED and POD. Materials and Methods: This is a prospective cohort study conducted at the National Institute of Mental Health and Neurosciences. After obtaining the ethics committee approval, consecutive adult patients scheduled for elective neurosurgical procedures from February 2018 to November 2018 were included. We excluded children, patients with preoperative Glasgow Coma score <15, and patients with preoperative delirium. ED was assessed using Riker's Sedation-Agitation Score and POD was assessed using Confusion Assessment Method. Data collection included patient demographics, details of anesthetics and analgesics, and neurosurgical details. Results: The incidence of ED and POD was 41% (N = 82/200) and 20% (N = 40/200), respectively. The occurrence of ED and POD coexisting as a continuous spectrum was 15%. Patients undergoing spine surgeries were found to have 44% less risk of ED than after cranial surgeries (P = 0.032). Presence of ED was associated with 1.8 times higher risk of POD (P < 0.001) and male gender was associated with 2.5 times higher risk of POD (P = 0.005). Conclusions: Incidences of ED and POD are higher after neurosurgery as compared with that reported in nonneurosurgical population previously.

Objective Previous studies have shown that the postoperative delirium rate does not differ between anesthetic techniques in randomized controlled trials. Subjective concerns such as anxiety and pain are often not adequately addressed in randomized controlled trials and reported to be associated with postoperative delirium. Shared decision-making is reported to have an impact on anxiety and pain. Therefore, the aim of this study was to evaluate the effect of shared decision-making while making a choice between spinal and general anesthesia on postoperative delirium incidence. Methods This prospective, observational, two-armed cohort study included 192 patients who underwent lower extremity, lower abdominal, pelvic, or perineal short-time surgery that lasted <90 min. The three-talk shared decision-making model was used to make the choice for the type of anesthesia. Depending on the shared decision-making process, either spinal anesthesia with short-acting local anesthetics (prilocaine hydrochloride or chloroprocaine hydrochloride) or general anesthesia was performed according to a standardized protocol including intraoperative electroencephalogram monitoring. Patients’ anxiety and pain levels were measured before and after the surgery using validated scales. Results Based on their shared decision-making choice of anesthesia, 97 patients were allocated to the spinal anesthesia group and 95 to the general anesthesia group. Postoperative delirium occurred less frequently after spinal anesthesia (2.1%) than after general anesthesia (16.8%; p < 0.001). No postoperative delirium was observed in patients who received only spinal anesthesia, as chosen using the shared decision-making model (spinal anesthesia: 0%, general anesthesia 16.8%; p < 0.001). Anxiety and pain levels did not differ between the two groups. Conclusions The incidence of postoperative delirium was lower in patients who were administered spinal anesthesia than in those who were administered general anesthesia after using a shared decision-making approach. Integrating patients’ perspectives and treatment preferences might change postoperative outcomes and should be taken into consideration in future trials. Trial registration: clinicaltrials.gov: NCT03715244 https://clinicaltrials.gov/study/NCT03715244?intr=NCT03715244&rank=1

Purpose Elderly patients with proximal femoral fractures are known to be a high-risk group for postoperative delirium (POD). The aim of this study was to determine the association of the benzodiazepine drug remimazolam with POD in elderly patients with proximal femoral fractures. Methods In this single-center retrospective observational study, we included patients aged 65 years or older who underwent general anesthesia for proximal femoral fractures. We collected data for the incidence of POD within 3 days after surgery. We also obtained data for complications, preoperative blood examinations, maintenance anesthetic and intraoperative vital data. The occurrence of POD in patients who received remimazolam for general anesthesia (remimazolam group) was compared to that in patients who received general anesthesia with other anesthetic agents (other group). We finally conducted a multivariate analysis to assess the independent association of remimazolam with the risk of POD. Results A total of 230 patients, including 54 patients who received remimazolam for maintenance anesthesia, were included in this study. The incidence of POD in the patients was 26.1%. The incidence of delirium within 3 days after surgery was significantly lower in the remimazolam group than in the other group (14.8% vs. 29.5%, p  =  0.03). The multivariate analysis showed that the use of remimazolam independently reduced the occurrence of POD (adjusted odds ratio  =  0.42, p   =  0.04). Conclusion This retrospective observational study showed that the use of remimazolam is independently associated with a reduced incidence of POD. Remimazolam may be considered as an option to reduce POD in elderly patients with proximal femoral fractures.

Background Postoperative delirium (POD) is a common complication in older patients. Multicomponent prevention reduces POD but requires substantial resources. The effect of single interventions derived from multicomponent programs remains elusive, but it is essential to assess their effect to identify which components are meaningful. This study investigates whether a single intervention from a multicomponent program may reduce the incidence of POD. Methods This prospective, single-center before-and-after study evaluated older surgery patients at a university hospital’s geriatric trauma center between July 2020 and November 2021. Inclusion criteria were age ≥ 70 years and a proximal femoral fracture. A control cohort (CC) left their dentures, vision, and hearing aids on the ward throughout surgery, while an intervention cohort (IC) used them until anesthesia induction and received them back when they regained consciousness. Therefore, IC obtained a transport case for hygienic storage and perioperative device management. The time of sensory aid removal was measured to ensure proper implementation. Outcomes were the incidence of POD (assessed via the 3-min Diagnostic Confusion Assessment Method at admission and twice daily for three days postoperatively), patient satisfaction, and recovery (evaluated via Quality of Recovery-9), length of hospital stay, postoperative monitoring time, Barthel-index, and 30-day mortality. Results 248 patients were screened for eligibility. Following a dropout rate of n  = 166, the cohorts were: CC n  = 40 and IC n  = 42. Both cohorts had similar baseline and treatment characteristics. The intervention significantly reduced the median time of sensory aid removal (CC 12h 14min, IC 12min, p  < 0.001), and the incidence of POD overall (CC 65.0%, IC 40.5%, p  = 0.026). The length of hospital stay and long-term recovery outcomes remained insignificant. However, postoperative monitoring time correlated with time of sensory aid removal (r s  = 0.518, p  < 0.001, n  = 62), and median quality of recovery improved on average (CC 12.75, IC 15.62, p  < 0.001). Conclusion Reduced perioperative sensory impairment may reduce the incidence of POD, decrease postoperative monitoring time, and be associated with a better postoperative recovery. Therefore, multimodal preventative efforts should include reducing sensory aid removal. Trial registration German Clinical Trial Register (DRKS-ID DRKS00022085); 07/07/2020