Perioperative medicine & outcomes
Association of propofol vs. sevoflurane maintenance anesthesia with postoperative delirium, cognitive decline, and mortality in older adults: a global comparative-effectiveness study
Main findingResult — go to the resultAdjusted hazard ratio 1.37 95% CI 1.25–1.48Authors' conclusion
In this large real-world cohort, propofol maintenance anesthesia was associated with higher risks of postoperative delirium, long-term cognitive decline, and mortality compared with sevoflurane, particularly in physiologically vulnerable patients.
Study context
- Population
- Adults aged 60–80 years undergoing surgery with GA
- Participants
- 45,545 vs 45,545
- Exposure
- Propofol vs sevoflurane maintenance anaesthesia
- Propofoln = 45,545
- Sevofluranen = 45,545reference
- Outcome
- Postoperative delirium
Methodological detailscomparative-effectiveness, multicentre, global federated health network, propensity-score matched (1:1), doubly robust Cox models
- Comparative-effectiveness
- Multicentre
- Global federated health network
- Propensity-score matched (1:1)
- Doubly robust Cox models
Main finding
As reported in the abstract
Adjusted hazard ratio
1.37
95% CI 1.25–1.48
By group
Propofol vs Sevoflurane
aHR 1.37 (95% CI 1.25–1.48)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Propofol | Sevoflurane | aHR (95% CI) | |
|---|---|---|---|---|
| 30-day mortality · propensity-score matched | 0.66% | 0.53% | 1.25 (1.05–1.48) | |
| 0.512Adjusted hazard ratio (log scale) |
- 30-day mortality — Greatest excess on postoperative day 1
- aHR 2.58
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Association of propofol vs. sevoflurane maintenance anesthesia with postoperative delirium, cognitive decline, and mortality in older adults: a global comparative-effectiveness study. Crit Care. Published 23 February 2026. doi:10.
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