The Red Blood Cell Distribution Width–Albumin Ratio Predicts Postoperative Delirium in the Elderly With Gastrointestinal Tumors: A Retrospective Cohort Study

ABSTRACT Aim Postoperative delirium ( POD ) is a frequent neurological complication following surgery, often leading to poor prognoses. The red blood cell distribution width ( RDW ) to albumin ratio ( RAR ), an emerging indicator of inflammation and nutrition, was extensively utilized for prognostic evaluation of neurological disorders in elderly patients. However, the relationship between RAR and POD was not evaluated. This study aimed to investigate the independent risk factors for POD and assess the predictive value of preoperative RAR among elderly patients who had gastrointestinal tumors. Methods We conducted a retrospective analysis to collect perioperative data on 203 patients aged 65 years or older undergoing gastrointestinal tumor surgery from November 2023 to August 2024. The risk factors for POD were detected through univariate and multivariate logistic regression analyses. Propensity score matching (PSM) was employed to make their clinical characteristics balanced. Results Out of 203 patients, 30 (14.8%) experienced POD, with a median age of 70 (range 67–76). Hypertension, creatinine, MCH, and RAR were determined as independent risk factors for POD through multivariate logistic regression analysis. In the post‐PSM cohort, RAR was still verified as a factor influencing POD. Conclusions Hypertension, creatinine, MCH, and RAR were recognized as independent risk factors for postoperative delirium in patients following gastrointestinal tumor surgery. Particularly, the preoperative RAR served as a more efficient index for predicting POD. Trial Registration Chinese Clinical Trial Center: ChiCTR2400094315