A long duration of intraoperative hypotension is associated with postoperative delirium occurrence following thoracic and orthopedic surgery in elderly

• Published in: Journal of clinical anesthesia 2023-09, Vol.88, p.111125-111125, Article 111125
• Main Authors: Duan, Wen, Zhou, Cheng-Mao, Yang, Jin-Jin, Zhang, Yue, Li, Ze-Ping, Ma, Da-Qing, Yang, Jian-Jun
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia; Blood pressure; Blood transfusions; Bone surgery; Brain; Cardiovascular disease; Confounding (Statistics); Delirium; Delirium - epidemiology; Delirium - etiology; Elderly; Emergence Delirium; General anesthesia; Hospitals; Humans; Hypertension; Hypotension; Hypotension - complications; Hypotension - etiology; Information systems; Injuries; Intraoperative hypotension; Orthopedic Procedures - adverse effects; Orthopedics; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative delirium; Risk Factors; Thoracic surgery
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2023.111125

Postoperative delirium (POD) is a common surgical complication associated with increased morbidity and mortality in elderly. Although the underlying mechanisms remain elusive, perioperative risk factors were reported to be closely related to its development. This study was designed to investigate the association between the duration of intraoperative hypotension and POD incidence following thoracic and orthopedic surgery in elderly. The perioperative data from 605 elderly undergoing thoracic and orthopedic surgery from January 2021 to July 2022 were analyzed. The primary exposure was a cumulative duration of mean arterial pressure (MAP) ≤ 65 mmHg. The primary end-point was the POD incidence assessed with confusion assessment method (CAM) or CAM-ICU for three days after surgery. Restricted cubic spline (RCS) was conducted to examine the continuous relationship between the duration of intraoperative hypotension and POD incidence adjusted with patients' demographics and surgery related factors. Then the duration of intraoperative hypotension was categorized into three groups: no hypotension, short (< 5 mins) or long duration (≥ 5 mins) of hypotension for further analysis. The incidence of POD was 14.7% (89 cases out of 605) within three days after surgery. The duration of hypotension presented a non-linear and “inverted L-shaped” effect on POD development. Compared to no hypotension, long duration (adjusted OR 3.93; 95% CI: 2.07–7.45; P