Impact of emergence delirium on long-term survival in older patients after major noncardiac surgery: A longitudinal prospective observational study

Study objective: To test the hypothesis that emergence delirium might be associated with worse long-term survival.

Design: A longitudinal prospective observational study.

Setting: A tertiary hospital in Beijing, China.

Patients: A total of 942 patients aged 65-90 years who were admitted to post-anesthesia care unit (PACU) after major noncardiac surgery under general anesthesia.

Exposures: Emergence delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit during PACU stay.

Measurements: Patients were followed up once a year for at least 3 years. Our primary endpoint was overall survival. Secondary endpoints included recurrence-free and event-free survivals. Associations between emergence delirium and long-term survivals were analyzed with the Cox proportional hazard models.

Main results: Among enrolled patients, 915 completed perioperative assessments; 906 completed long-term follow-up (mean age 72 years; 60 % [545/906] male; 73 % [660/906] cancer surgery). At the end of follow-up (median 43 months), there were 69 deaths in 331 patients (21 %) with emergence delirium versus 114 deaths in 575 patients (20 %) without: unadjusted hazard ratio 1.10 (95 % CI: 0.81 to 1.48); P = 0.547; adjusted hazard ratio 0.96 (95 % CI: 0.70 to 1.32); P = 0.797. Recurrence-free survival was 73/331 (22 %) in patients with emergence delirium versus 121/575 (21 %) without: unadjusted hazard ratio 1.08 (95 % CI: 0.81 to 1.45); P = 0.598; adjusted hazard ratio 0.94 (95 % CI: 0.69 to 1.28); P = 0.695. Event-free survival was 159/331 (48 %) in patients with emergence delirium versus 268/575 (47 %) without: unadjusted hazard ratio 1.06 (95 % CI: 0.87 to 1.29); P = 0.563; adjusted hazard ratio 0.98 (95 % CI: 0.80 to 1.21); P = 0.875.

Conclusions: We did not find significant association between emergence delirium and worse long-term survival in older patients after general anesthesia and major surgery mainly for cancer. The effects of emergence delirium on long-term outcomes deserve further investigation.

Clinical trial registrations: www.chictr.org.cn; ChiCTR-OOC-17012734.