Factors associated with postoperative delirium and development of an exploratory prediction model in elderly orthopedic surgery patients anesthetized with ciprofol

This study investigated postoperative delirium (POD) predictors in 337 elderly orthopedic surgery patients anesthetized with ciprofol. The incidence of POD was 19.9%. Factors associated with POD included higher geriatric depression (GDS-15) scores, lower Prognostic Nutritional Index (PNI), elevated postoperative neurofilament light chain (NfL), and greater sleep fragmentation on the first postoperative night. The developed prediction model demonstrated moderate discrimination (AUC 0.703), good calibration, and potential clinical utility via decision curve analysis. Findings suggest that depression, nutritional status, neural injury, and sleep-related measures may contribute to POD risk stratification. However, these findings are exploratory and require external validation before informing targeted perioperative interventions.