Associations of Postoperative Delirium With Perioperative Frailty Worsening and Their Combined Effect on 1-Year Mortality in Older Surgical Patients

Chinese PLA General Hospital6,196 enrolled

Overview

Postoperative delirium (POD) is a frequent complication in older surgical patients and is associated with adverse outcomes, while frailty is also highly prevalent during the perioperative period. This study aimed to determine whether POD accelerates perioperative frailty worsening and to assess the effect of their coexistence on 1-year mortality.

Study Type

OBSERVATIONAL

Enrollment

6,196

Conditions

Postoperative Delirium (POD)Frailty at Older Adults Mortality Recovery of Function

Eligibility

Sex: ALLMin age: 65 Years

Medical Language ↔ Plain English

Inclusion criteria: 1. Aged ≥65 years; 2. Scheduled for elective non-cardiac, non-neurosurgical procedures; 3. Consented to undergo preoperative health and functional state assessments. Exclusion criteria: 1. Had severe dementia, language disorders, significant hearing or visual impairments, or were in a coma; 2. Had Mini-Mental State Examination (MMSE) scores below the established educational thresholds: \<18 for illiterate individuals, \<21 for those with primary education (≤6 years), and \<25 for those with secondary education or higher (\>6 years) 3. Underwent local anesthesia or monitored anesthesia care; 4. Had an operative time ≤30 minutes; 5. Incomplete preoperative FRAIL scale assessment; 6. Missing postoperative delirium data; 7. Incomplete FRAIL scale assessment at 1 month postoperatively.

Outcomes

Primary Outcomes

The primary outcome was worsened frailty at one month after surgery.

Frailty was assessed preoperatively by trained researchers using the FRAIL scale, which includes five items: fatigue, resistance, ambulation, illnesses, and weight loss. Each item scores 0 or 1, for a total of 0-5 points, with higher scores indicating greater frailty. Patients were categorized as robust (0), pre-frail (1-2), or frail (3-5). A follow-up frailty assessment was conducted one month postoperatively via telephone. Frailty change was defined as the difference between postoperative and preoperative scores: ≤0 indicated stable/improved frailty, and \>0 indicated worsened frailty.

Time frame: At one month after surgery.

Secondary Outcomes

The secondary outcome was 1-year all-cause mortality.

A structured telephone follow-up was conducted one year after surgery to determine outcomes.

Time frame: At one year after surgery.