Perioperative medicine & outcomes
Body Mass Index (BMI), Comorbidity Burden, and Postoperative Delirium in Older Adults: A Retrospective Cohort Study
Authors' conclusion
The relationship between BMI and POD is not uniform; it is conditional on comorbidity burden. Overweight and class 1 obesity are associated with reduced POD risk only in older adults with low comorbidity burden.
Study context
- Population
- Patients aged ≥65 years undergoing noncardiac, non-neurological surgery under GA (2015–2024); BMI <18.5 kg/m² excluded
- Participants
- 4,320 patients
- Exposure
- BMI categories vs normal weight, by comorbidity burden
- Outcome
- POD, assessed daily with Korean-validated Confusion Assessment Method (CAM) or CAM for the intensive care unit (CAM-ICU)
- Follow-up
- Within 7 postoperative days
Methodological detailsprespecified BMI × Charlson Comorbidity Index (CCI) interaction analysis, propensity score matching (supportive), restricted cubic spline (supportive)
- Prespecified BMI × CCI interaction analysis
- Propensity score matching (supportive)
- Restricted cubic spline (supportive)
Main finding
As reported in the abstract
POD
Each group vs normalAdjusted odds ratio (95% CI)
Overweight
0.81(0.68–0.96)
Class 1 obesity
0.76(0.60–0.97)
Class ≥2 obesity
1.02(0.78–1.33)
Overweightlow CCI (0-2)
0.69(0.53–0.90)
Class 1 obesitylow CCI (0-2)
0.65(0.46–0.92)
- Postoperative delirium (POD) overall
- 625 of 4320 (14.5%)
- BMI × CCI interaction
- P = 0.040
Observational data: associations, not effects.
Further findings
| Outcome | OR (CI) | |
|---|---|---|
| POD, propensity score-matched (supportive analysis)Overweight vs Normal · consistent with primary analysis | 0.74 (0.60–0.90) | |
| POD, propensity score-matched (supportive analysis)Class 1 obesity vs Normal · consistent with primary analysis | 0.72 (0.53–0.98) | |
| 0.512Odds ratio (log scale) |
Original publication
BMI, Comorbidity Burden, and Postoperative Delirium in Older Adults: A Retrospective Cohort Study. Anesth Analg. Published 2 September 2026. doi:10.
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