Perioperative medicine & outcomes
Effect of acute pain on the association between preoperative cognitive impairment and postoperative delirium: a secondary analysis of three trials
Authors' conclusion
The association between preoperative cognitive impairment and delirium is significantly mediated by acute pain in patients after noncardiac surgery.
Study context
- Population
- Patients aged ≥55 yr undergoing elective noncardiac surgery
- Participants
- 1,497 patients
- Comparison
- Preoperative cognitive impairment vs no cognitive impairment
- Cognitive impairmentn = 603
- No cognitive impairmentn = 894reference
- Primary endpoint
- Occurrence of delirium
- Follow-up
- First 5 postoperative days
Methodological detailsmediation analysis
- Mediation analysis
Primary result
As reported in the abstract
Delirium within 5 days · 5 days
Total association (adjusted β)
8.3%
95% CI 4.8–12.0%P < 0.001
Delirium within 5 days
Direct association (adjusted β)
7.8%
95% CI 4.4–12.0%P < 0.001
Delirium within 5 days
Indirect association via acute pain (adjusted β)
0.4%
95% CI 0.1–1.0%P = 0.006
accounting for 4.9% of the total effect
Further findings
Median
| Outcome | Cognitive impairment | No cognitive impairment | P value |
|---|---|---|---|
| TWA pain score with movement (NRS) · within 72 h | 4 (IQR 3–5) | 3 (IQR 2–5) | P = 0.004 |
Prevalence of preoperative cognitive impairment (MMSE <27)
- Prevalence of preoperative cognitive impairment
- 40.3% (603/1497)
Original publication
Effect of acute pain on the association between preoperative cognitive impairment and postoperative delirium: a secondary analysis of three trials. Br J Anaesth. Published 3 August 2022. doi:10.
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