Association between COVID-19 history and postoperative delirium in elderly patient undergoing elective surgery: a prospective, two-center observational cohort study

Anesthesiology and Perioperative Science Pub Date : 2025-02-14 DOI:10.1007/s44254-025-00088-4

Wen Duan, Jin-Jin Yang, Pan-Pan Fang, Wen-Jie Zhu, Yue Zhang, Xin-Yu Li, Da-Qing Ma, Yang-Yang Shan, Xue-Sheng Liu, Jian-Jun Yang

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Abstract

Purpose

An increased incidence of delirium was reported in patients especially in elderly patient during the acute phase of coronavirus disease 2019 (COVID-19). However, whether COVID-19 history increases the risk of postoperative delirium (POD) in elderly patients remains unclear. This study aims to investigate the association between COVID-19 history and POD in elderly patients undergoing elective surgeries.

Methods

In this prospective, two center cohort study, 500 elderly patients undergoing elective surgeries from March to May 2023 were analyzed. The primary exposure was a history of COVID-19. The primary outcome was POD assessed with 3-min diagnostic confusion assessment method or confusion assessment method for the intensive care unit within three days after surgery. We used inverse probability of treatment weighting (IPTW) to balance the differences between patients with or without a history of COVID-19. The association between COVID-19 history and POD was estimated using a logistic regression model with IPTW. Additionally, we next exploringly conducted subgroup analysis and assessed interaction effects to evaluate the impact of COVID-19 history on POD based on frailty/pre-frailty, cancer, surgical type/classification, sex, profession, and residence type.

Results

In this cohort, 412 patients had a history of COVID-19 with an incidence 16% of POD while 88 were uninfected with 15.9% of POD incidence. There was no association between COVID-19 history and POD [adjusted odds ratio (OR_adj) 1.20 (0.80–1.79), P = 0.378] in elderly patients undergoing elective surgery. However, POD was significantly increased in patients with COVID-19 history who were pre-frailty/frailty or with cancers [OR_adj 2.41 (1.19–5.10) and OR_adj 2.29 (1.23–4.39), respectively].