Perioperative medicine & outcomes
Intraoperative hypotension and postoperative delirium among older high-risk patients undergoing major noncardiac surgery: a retrospective single-centre cohort study
Authors' conclusion
Although intraoperative hypotension initially appeared to be associated with postoperative delirium, this association was no longer significant when accounting for temporal improvements in perioperative care.
Study context
- Population
- Adults ≥60 yr, ASA 3 or 4, undergoing major noncardiac surgery with documented CAM assessments; excluding prior neurosurgery, stroke, dementia or neurocognitive disorders2,013–2024
- Participants
- 5,171 adults
- Exposure
- Cumulative duration of intraoperative MAP <65 mm Hg
- Outcome
- Postoperative delirium (Confusion Assessment Method)
- Follow-up
- Within 7 days
Methodological detailssingle-centre, multivariable logistic regression
- Single-centre
- Multivariable logistic regression
Main finding
As reported in the abstract
Postoperative delirium within 7 days · 7 days
Intraoperative hypotensionOdds ratio (95% CI)P value
Per 60 min; adjusted for patient characteristics and perioperative factors
1.12(1.01–1.24)
P = 0.038After additionally adjusting for year of surgery; no longer statistically significant
1.06(0.95–1.18)
P = 0.320Per 60 min, as printed
- Developed delirium
- 632 (11.8%)
Observational data: associations, not effects.
Further findings
Duration of surgery and time with MAP <65 mm Hg
- Duration of surgery, median (Q1-Q3), min
- 281 (199-430)
- Time with MAP <65 mm Hg, median (Q1-Q3), min
- 28 (9-61)
Temporal trends
- Both intraoperative hypotension exposure and delirium incidence declined significantly over the study period
Original publication
Intraoperative hypotension and postoperative delirium among older high-risk patients undergoing major noncardiac surgery: a retrospective single-centre cohort study. BJA Open. Published 15 October 2025. doi:10.
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