Key result
Preoperative lacunar infarcts significantly increased the risk of postoperative delirium compared to no infarcts (39.1% vs 27.9%, RR 1.66) in elderly patients undergoing major abdominal surgery.
Why the study?
To investigate whether the presence of preoperative lacunar infarcts was associated with postoperative delirium in elderly patients undergoing elective major abdominal surgery.
Does the presence of preoperative lacunar infarcts increase the risk of postoperative delirium in elderly patients undergoing major abdominal surgery?
Cohort (n=369)
No
Does the presence of preoperative lacunar infarcts increase the risk of postoperative delirium in elderly patients undergoing major abdominal surgery?
Preoperative lacunar infarcts are a significant risk factor for postoperative delirium and are associated with lower intraoperative regional cerebral oxygen saturation in elderly patients undergoing major abdominal surgery.
Answers are grounded in this paper and cite their sources.
Preoperative LACI was associated with POD in elderly abdominal surgery patients; hypothesis-generating and should not yet change practice.
Objective The primary goal was to investigate whether the presence of preoperative lacunar infarcts (LACI) was associated with postoperative delirium (POD) in elderly patients undergoing elective major abdominal surgery. Design A prospective cohort study. Setting and participants Patients aged ≥ 65 years from a tertiary level A hospital in China. Methods The POD was assessed once daily within the first postoperative 3 days using the Confusion Assessment Method. Neurocognitive tests using the Mini-mental State Examination (MMSE) and the Beijing version of the Montreal Cognitive Assessment scales were carried out within 3 days before surgery and 4–7 days after surgery. Regional cerebral oxygen saturation (rScO 2 ) was recorded in the operating room. Logistic regression analysis was used to evaluate the impact of preoperative LACI on POD and to explore the risk factors for POD. Results A total of 369 participants were analyzed, 161 in the preoperative LACI-positive group (P group), and 208 in the preoperative LACI-negative group (N group), respectively. The incidence of POD was 32.7% in our study. The incidence of POD was significantly higher in the P group than in the N group (39.1 vs 27.9%, risk ratio, 1.66; 95% CI 1.07–2.58; P = 0.022). Furthermore, the P group exhibited lower mean rScO 2 values during the procedure ( P < 0.001). In exploratory analysis, the advanced age ( P = 0.005), sex ( P = 0.038), and lower preoperative MMSE score ( P = 0.019) were independent risk factors for POD in patients undergoing major abdominal surgery. Conclusions and implications Preoperative LACI was common, and constituted a risk factor for POD in older patients undergoing abdominal surgery. Despite the frequent subclinical nature, the preoperative LACI led to lower mean rScO 2 during the procedure. These findings could help early identification of high-risk POD patients.
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Li et al. (2025) conducted a cohort in Postoperative delirium (n=369). Preoperative lacunar infarcts vs. No preoperative lacunar infarcts was evaluated on Postoperative delirium (POD) within the first 3 days (RR 1.66, 95% CI 1.07-2.58, p=0.022). Preoperative lacunar infarcts significantly increased the risk of postoperative delirium compared to no infarcts (39.1% vs 27.9%, RR 1.66) in elderly patients undergoing major abdominal surgery.
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