Prehabilitation is associated with a reduced incidence of postoperative delirium in patients undergoing pancreatoduodenectomy: a propensity score-matched cohort study.

BACKGROUND

Delirium is a common complication following pancreatic surgery and negatively influences postoperative recovery. Prehabilitation may reduce postoperative delirium, potentially by attenuating systemic inflammation.

METHODS

In this retrospective propensity score-matched cohort study, patients undergoing pancreatoduodenectomy who received prehabilitation were compared to an historical control cohort. Delirium was assessed using a validated chart-based method based on DSM-5 criteria. Primary outcome was the association between prehabilitation and postoperative delirium. Secondarily, the association with pre- and postoperative C-reactive protein (CRP) and leukocyte levels was assessed.

RESULTS

In total, 239 patients were included, comprising 119 in the historical and 120 in the prehabilitation cohort. Delirium occured in 26 historical patients (21.2%) versus 12 (10.0%) in the prehabilitation cohort, p = 0.014. After adjusting for age and major complications, prehabilitation remained significantly associated with reduced odds ratio of delirium (OR 0.338, 95%-CI 0.154-0.743, p = 0.007). CRP was significantly lower on postoperative day 1 in the prehabilitation cohort (83.0 vs 94.0 mg/L, p = 0.005), but not preoperatively and on postoperative day 2 and 3. Leukocyte levels did not differ between cohorts.

CONCLUSION

Prehabilitation is associated with a significantly lower incidence of delirium following pancreatoduodenectomy, independent of age or major complications. Although CRP was lower on postoperative day 1 in the prehabilitation cohort, this difference did not persist. These findings support the prehabilitation as a promising delirium prevention strategy in surgical patients, warranting further research on the underlying mechanisms.