Delirium after surgery - a retrospective study of predictors, complications, and screening patterns in the national surgical quality improvement program

Q: How was postoperative delirium assessed in the study?

Delirium assessment data came from the 2021–2023 ACS-NSQIP dataset. Patients were categorized as delirium, non-delirium, or unscreened, with additional analysis of 2.7 million unscreened patients to evaluate selection bias.

Q: What factors and outcomes were associated with delirium?

Delirium was associated with older age, greater functional dependence, higher ASA class and comorbidity burden, and factors such as dementia, recent falls, and urgent/emergency surgery. It was independently linked to higher 30-day mortality, reoperation, surgical complications, loss of independence, and lower odds of home discharge.

Sep 29, 2026

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Postoperative delirium is a serious, underrecognized surgical complication with major consequences for morbidity, mortality, and long-term cognitive function. A retrospective analysis used 2021–2023 ACS-NSQIP data, covering 217,783 adults with documented delirium assessment and an additional 2.7 million unscreened patients to evaluate selection bias. Delirium screening occurred only in patients aged ≥75 years, with low coverage, and was linked to increased 30-day mortality, complications, reoperation, functional decline, and reduced home discharge probability.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

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Articles Delirium after surgery: a retrospective study of predictors, complications, and screening patterns in the national surgical quality improvement program Adriana C. Panayi,a,b Sarah Friedrich,c Jasmin Rühl,c Thomas Schaschinger,d Tobias Niederegger,d Leonard Knoedler,a Samuel Knoedler,e Carsten Rendenbach,a Sascha Treskatsch,f Leila Harhaus,b Max Heiland,a Dennis P. Orgill,e and Gabriel Hundeshageng,∗ aCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Berlin, Germany bDepartment of Hand, Replantation, and Microsurgery BG Klinikum Unfallkrankenhaus Berlin and Chair of Hand, Replantation, and Microsurgery at the Charité Universitätsmedizin Berlin, Germany cDepartment of Mathematical Statistics and Artificial Intelligence in Medicine, University of Augsburg, Augsburg, Germany dMedical Faculty, University of Heidelberg, Heidelberg, Germany eDivision of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USAfCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany gDepartment of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, 67071, Germany Summary Background Postoperative delirium is a serious yet underrecognized complication affecting diverse surgical populations, with profound implications for morbidity, mortality, and long-term cognitive function. Its prediction remains imprecise, and screening practices vary widely. Methods We conducted a retrospective analysis of the 2021–2023 data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) . The study included 217,783 adult surgical patients with documented delirium assessment. Patients were categorized as delirium, non-delirium, or unscreened, with an additional 2.7 million unscreened patients analyzed to assess selection bias in screening. The primary outcome was the incidence of delirium. Other outcomes included surgical and medical complications, mortality, length of stay, functional decline, discharge destination and conditions, and perioperative lab values. Multivariable regression models were used to identify independent predictors of delirium and its associated outcomes. Findings Delirium screening was performed exclusively in patients aged ≥75 years, accounting for 7.3% of all surgical patients. Screening rates declined with advancing age (44% of patients aged 90+ vs 56% aged 75–79), while the proportion screening positive increased sharply (3.1% at 75–79 years vs 12.8% at ≥90 years) . Delirium occurred in 10.6%(n = 23,100) of screened patients. Compared with non-delirium patients, those with delirium were older (mean 81.3 vs 79.9 years, p < 0.0001), more functionally dependent, and had higher ASA class and comorbidity burden. Dementia (37% vs 7.9%, p < 0.0001), recent falls (40% vs 18%, p < 0.0001), and urgent/emergency surgery (55% vs 26%, p < 0.0001) were strongly associated. Each 10-min increase in operative time was seen to independently be associated with 2.3% raised odds of delirium (p < 0.0001) . Delirium was independently associated with higher 30-day mortality (OR 3.2, 95% CI 2.9–3.5), reoperation (OR 2.3, 95% CI 2.1–2.5), surgical complications (OR 1.8, 95% CI 1.6–1.9), loss of independence (OR 1.6, 95% CI 1.5–1.7), and reduced odds of home discharge (OR 0.5, 95% CI 0.4–0.5) . Interpretation Postoperative delirium is an independent predictor of adverse surgical outcomes yet remains substantially under-screened, with disparities across patient groups. These findings underscore the need for standardized, routine screening and targeted pr

FAQs

How was postoperative delirium assessed in the study?

Delirium assessment data came from the 2021–2023 ACS-NSQIP dataset. Patients were categorized as delirium, non-delirium, or unscreened, with additional analysis of 2.7 million unscreened patients to evaluate selection bias.

Who received delirium screening, and how did screening rates change by age?

Delirium screening was performed exclusively in patients aged ≥75 years. Screening rates declined with advancing age, while the proportion of positive screens increased sharply in older age groups.

What factors and outcomes were associated with delirium?

Delirium was associated with older age, greater functional dependence, higher ASA class and comorbidity burden, and factors such as dementia, recent falls, and urgent/emergency surgery. It was independently linked to higher 30-day mortality, reoperation, surgical complications, loss of independence, and lower odds of home discharge.

Sep 29, 2026

Uploaded by Marglet