What is the clinical evidence from this study?

Study design: Cohort. Population: Older surgical patients aged ≥65 years undergoing elective non-cardiac, non-neurological surgery (n=6196). Intervention: Postoperative delirium (POD) vs. No postoperative delirium. Primary outcome: Perioperative frailty worsening defined as increase in FRAIL score 1 month postoperatively compared to preoperative score (OR 1.851, 95% CI 1.541–2.224, p=<0.001).

What question did this study set out to answer?

This research aimed to examine how postoperative delirium affects frailty changes in surgical patients and its impact on mortality.

March 7, 2026Open Access

Associations of postoperative delirium with perioperative frailty worsening and their combined effect on 1-year mortality in older surgical patients: a prospective cohort study

Q: What are the key findings of this study?

Postoperative delirium was independently associated with a 85.1% increased odds of perioperative frailty worsening (OR 1.851, 95%CI 1.541–2.224, P < 0.001) in older surgical patients.

Q: What question did this study set out to answer?

This research aimed to examine how postoperative delirium affects frailty changes in surgical patients and its impact on mortality.

Key Result

Postoperative delirium was independently associated with a 85.1% increased odds of perioperative frailty worsening (OR 1.851, 95%CI 1.541–2.224, P < 0.001) in older surgical patients.

Key Points

This research aimed to examine how postoperative delirium affects frailty changes in surgical patients and its impact on mortality.
Conducted a prospective cohort study on older surgical patients
Assessed levels of postoperative delirium and frailty
Monitored 1-year mortality rates based on delirium and frailty status
Postoperative delirium significantly worsened perioperative frailty levels
The coexistence of delirium and increased frailty resulted in a markedly higher risk of 1-year mortality
Implementing early recognition and management strategies for delirium could reduce frailty and improve survival

Study Design

Type

Cohort (n=6,196)

Multicenter

Yes

Structured PICO

Does postoperative delirium increase the risk of perioperative frailty worsening and 1-year mortality in older surgical patients?

Population

6,196 patients aged ≥65 years undergoing elective non-cardiac, non-neurological surgery in China. Median age 71, 43.3% female. Key exclusions: severe dementia, language disorders, significant hearing/visual impairments, coma, cognitive impairment (MMSE below education-adjusted thresholds), surgery under local/monitored anesthesia, operative time ≤30 min.

Intervention

Development of postoperative delirium (POD) assessed via the 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) scale from postoperative day 1 to day 5 and on day 7 or until discharge.

Comparator

No development of postoperative delirium (non-POD).

Outcome

Worsened frailty at 1 month after surgery (defined as an increase in the postoperative FRAIL score compared with the preoperative score).patient reported

Postoperative delirium accelerates perioperative frailty worsening, and their coexistence substantially increases the risk of 1-year mortality in older surgical patients.

Main Result

Effect estimate: OR 1.851 (95% CI 1.541–2.224)

Absolute Event Rate: 41.7% vs 28.5%

p-value: p=<0.001

Limitations

High missing rate (23.8%) of frailty assessments at 1 month post-surgery may introduce bias
Exclusion of patients with preoperative cognitive impairment limits generalizability
Lack of detailed postoperative rehabilitation data influences interpretation of recovery
Study period overlapped COVID-19 pandemic, potentially affecting surgical care and outcomes

Abstract

POD accelerates perioperative frailty worsening in older surgical patients, and their coexistence substantially increases 1-year mortality risk. Early recognition and proactive management of POD may help mitigate frailty progression and improve long-term survival.

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Cite This Study

Han et al. (Thu,) conducted a cohort in Older surgical patients aged ≥65 years undergoing elective non-cardiac, non-neurological surgery (n=6,196). Postoperative delirium (POD) vs. No postoperative delirium was evaluated on Perioperative frailty worsening defined as increase in FRAIL score 1 month postoperatively compared to preoperative score (OR 1.851, 95% CI 1.541–2.224, p=<0.001). Postoperative delirium was independently associated with a 85.1% increased odds of perioperative frailty worsening (OR 1.851, 95%CI 1.541–2.224, P < 0.001) in older surgical patients.

synapsesocial.com/papers/69abc2255af8044f7a4eb704 https://doi.org/https://doi.org/10.1007/s41999-026-01423-z

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