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TOPLINE:

Nearly 20% of patients who underwent surgery experienced postoperative delirium in the postanesthesia care unit (PACU), with the risk being significantly higher in those reporting high levels of preoperative anxiety. The implementation of a brain care bundle helped in the management of postoperative pain, anxiety, nausea, and vomiting in the PACU, researchers found.

METHODOLOGY:

• Researchers conducted an observational prospective study at a Swiss hospital from January 2023 to January 2024 to assess whether patient-reported outcomes and experiences influenced the risk for postoperative delirium.
• They included 1412 adults (mean age, 58.8 years; 51.2% women) who underwent elective or urgent surgery, with a stay in the PACU after the procedure.
• The Safe Brain Initiative care bundle — incorporating multidisciplinary, nonpharmacologic strategies to optimize perioperative brain health — was implemented.
• Patients reported pain, anxiety, stress, thirst, and nausea on a scale of 0-10 at four timepoints: before surgery, on arrival to the PACU, on discharge from the PACU, and at their worst moment in the unit.
• The primary outcome was the incidence of postoperative delirium, defined as a Nursing Delirium Screening Scale score of 2 or higher.

TAKEAWAY:

• Postoperative delirium occurred in 19.6% of patients in the PACU; those who experienced delirium reported having higher levels of pain, anxiety, and stress than those who did not.
• High levels of preoperative anxiety (Numeric Rating Scale score, > 7) independently predicted postoperative delirium (P = .012).
• Length of stay in the PACU, surgical time exceeding 3 hours, type of anesthesia, and high levels of preoperative pain during mobilization were found to be significant predictors of postoperative delirium (P < .05).
• Postoperative pain, anxiety, nausea, and vomiting in the PACU tended to decrease over time, which could be attributed to the implementation of brain care bundle.

IN PRACTICE:

“Our findings highlight the critical role of preoperative pain, anxiety, and stress on postoperative delirium [POD]. In our cohort, patients who developed POD reported higher levels of pain, anxiety, and stress before surgery,” the researchers reported.

“Elevated preoperative anxiety and pain likely indicate underlying psychological vulnerability or a heightened stress response, which exacerbates postoperative distress and increases the risk of PACU POD. This connection underscores the importance of preoperative psychological assessments and interventions to identify and support at-risk patients,” they added.

SOURCE:

This study was led by Joana Berger-Estilita of Salem-Spital of Hirslanden Hospital Group in Bern, Switzerland. It was published online on August 22, 2025, in the European Journal of Anaesthesiology.

LIMITATIONS:

This study was conducted at a single center, which may limit its generalizability. Only one assessment tool was used to identify postoperative delirium. Delirium identified immediately upon arrival may reflect lingering effects of anesthesia, potentially introducing misclassification and leading to overestimation of the true rates of delirium.

DISCLOSURES:

This study received support for statistical analysis from a private fund from SANAG AG. One author reported being a member of the Board of Directors of the European Society of Anesthesiology and Intensive Care. Four authors reported receiving speaker’s fees from Medtronic and another from Merck. One author reported developing and participating in the implementation of the Safe Brain Initiative care bundle.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.