Postoperative delirium and 1-year functional decline, institutionalization and mortality.

O. de la Varga-Martínez Rosalía Navarro Pérez R. López-Herrero E. Santamaría-Vázquez Gema Rodríguez-Cerón B. Martínez-Rafael Á. Becerra-Bolaños A. M. Espinosa Moreno M. de la Rosa-Estadella N. Bugueño Marta Giné Servén A. Martínez López Diana Marcela Narváez Cubillos Marta Eugenia Infante Morales L. A. Gómez Arredondo Alma Casasempere-Sanus Jorge Almoguera Fernández Rebeca Badenes-García Nekane Romero-García B. Darias-Delbey Guadalupe Población García Rita Veloso de Sousa M. Heredia-Rodríguez Cristina Tobar Gonzalo J. M. Marcos-Vidal Carolina Ferrer Gómez L. Varela-Rodríguez L. Contreras-López Laura Pariente Juste M. Alonso Fernández Ricardo Fernández Fernández Cristina Sánchez González E. Del Val Peciña M. A. Rodríguez Conesa Almudena González Pereira Aurora Herrera-Soto Á. Rodríguez Álvarez I. de la Torre Riveiro Gustavo Illodo Miramontes Itzamara Loo Yau Carla Delgado-Martí R. Poves-Álvarez M. Varela Durán Rafael Badenes Eduardo Tamayo

Oct 2026 · European Journal of Anaesthesiology · 0 citations · 30 references

Medicine

Abstract

Background

Postoperative delirium is a common and serious complication in older surgical patients and has been associated with increased morbidity, healthcare costs, long-term functional decline and mortality.

Objective

To determine whether postoperative delirium is associated with functional status, quality of life, institutionalisation and mortality at 1 year after surgery in a large multicentre surgical cohort.

Design

Prospective multicentre observational study.

Setting

Forty-three hospitals in Spain. Surgical patients were recruited in November 2023 and assessed for delirium 48 h after surgery, with follow-up at 1 year. PATIENTS, OTHER

Participants

A total of 2442 adult surgical patients undergoing elective or urgent procedures requiring hospital admission. Postoperative delirium was assessed using the Confusion Assessment Method (CAM), CAM for the Intensive Care Unit (CAM-ICU) or the telephone-administered 4AT according to clinical setting.

Interventions

None. MAIN OUTCOME MEASURES Functional status and quality of life at 1 year assessed using the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0). Secondary outcomes included institutionalisation and mortality.

Results

After excluding 81 deaths and 462 nonresponders, the 1-year telephone follow-up was completed for 1899 patients. Postoperative delirium within the first 48 h was independently associated with a 4.6-point higher WHODAS score at 1 year: adjusted mean difference = 4.60 [95% confidence interval (CI), 1.57 to 7.64, P = 0.003]. Delirium was also associated with increased institutionalisation and higher mortality: odds ratio (OR) 2.5 (95% CI, 1.07 to 5.84, P = 0.03), and (16.7 vs. 3.1%; P < 0.001), including 30-day, 60-day, and 365-day mortality (all P < 0.001), respectively.

Conclusions

Postoperative delirium is independently associated with long-term functional decline, loss of independence, institutionalisation and increased 1-year mortality. These findings highlight delirium as a key perioperative complication and support prevention strategies and structured long-term follow-up after surgery. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NC-T06127901).

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