Can individualized blood pressure control prevent delirium after surgery in high-risk patients with sleep disorders?

BACKGROUND

Postoperative delirium (POD) has many adverse effects on patients, yet the influence of intraoperative blood pressure on POD remains contentious. Sleep disorders have been proposed as a potential risk factor for POD, although limited prospective studies have been conducted on this topic. This study aimed to explore what target level of intraoperative blood pressure can effectively reduce the incidence of POD in patients with preoperative sleep disorders.

METHODS

A total of 124 patients scheduled for elective gastrointestinal tumor surgery who exhibited preoperative sleep disturbances were randomized into two groups. The higher blood pressure group (Group H) maintained intraoperative mean arterial pressure (MAP) at 20% above baseline, whereas the lower blood pressure group (Group L) maintained MAP at 20% below baseline. The primary outcome was the incidence of POD (including the overall incidence within 3 days after surgery and per day).

RESULTS

Complete outcome data were obtained from 114 patients (Group H, n = 57, Group L, n = 57). POD was observed in 7 patients (12.3%) in Group H and 12 patients (21.1%) in Group L. There was no significant difference in the incidence of delirium within 3 days postoperatively between the two groups (P = 0.209), nor in the first, second, or third days after surgery.

CONCLUSION

Among patients with preoperative sleep disturbances, maintaining intraoperative MAP at either 20% above or below baseline does not significantly influence the incidence of postoperative delirium. TRAIL REGISTRATION: IRB: KY-20220826001–02, date: August 26, 2022. ChiCTR: ChiCTR2300071264.