Cardiothoracic & vascular anaesthesia
Benzodiazepine-Free Cardiac Anesthesia for Reduction of Postoperative Delirium: A Cluster Randomized Crossover Trial
Errata to this article were published (JAMA Surg, 1 May 2025 ↗ · 1 Jan 2026 ↗)
Primary resultResult — go to the resultAdjusted odds ratio 0.92 95% CI 0.84–1.01Authors' conclusion
In intention-to-treat analyses, restricting benzodiazepines during cardiac surgery did not reduce delirium incidence but was also not associated with an increase in the incidence of patient-reported intraoperative awareness.
Study context
- Population
- Adults undergoing open cardiac surgery at 20 North American cardiac surgical centers, Nov 2019–Dec 2022
- Participants
- 19,768 adults · 20 centers
- Comparison
- Restricted vs Liberal
- Restrictedn = 9,827
- Liberaln = 9,941reference
- Primary endpoint
- Delirium detected in routine clinical care (CAM-ICU or Intensive Care Delirium Screening Checklist)
- Follow-up
- Within 72 hours of surgery
Methodological detailspragmatic, multiperiod, patient- and assessor-blinded, cluster randomized crossover, multicentre, Waiver of individual patient consent, Hospitals (clusters) crossed between policies 12 to 18 times over 4-week periods
- Pragmatic
- Multiperiod
- Patient- and assessor-blinded
- Cluster randomized crossover
- Multicentre
- Waiver of individual patient consent
- Hospitals (clusters) crossed between policies 12 to 18 times over 4-week periods
Primary result
As reported in the abstract
Adjusted odds ratio
0.92
95% CI 0.84–1.01
P = 0.07
Events by treatment group
Restricted vs Liberal
aOR 0.92 (95% CI 0.84–1.01); P = 0.07
Further findings
Adherence to assigned policy
Safety
- No patient spontaneously reported intraoperative awareness
Original publication
Benzodiazepine-Free Cardiac Anesthesia for Reduction of Postoperative Delirium: A Cluster Randomized Crossover Trial. JAMA Surg. Published 1 March 2025. doi:10.
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