The Efficacy of a Multidisciplinary Perianesthetic Management Bundle for Alleviating Delirium After Thoracic Surgery: A Randomized Clinical Trial.

OBJECTIVES

Postoperative delirium significantly worsens surgery prognosis. Here, the authors assessed the ability of comprehensive perianesthetic management to reduce the risk of delirium after thoracic surgery.

DESIGN

This was a prospective, randomized, single-blind study.

SETTING

The study was conducted at a tertiary care institution and university-level teaching hospital.

PARTICIPANTS

A total of 508 patients scheduled to undergo elective thoracic surgeries with an expected anesthesia duration of at least 2 hours were enrolled.

INTERVENTIONS: All eligible participants received routine pre- and postoperative nonpharmacologic interventions, and the intervention group also received comprehensive perianesthetic management, including perioperative pain control, rational medication, refined intraoperative management, and cognitive training. Delirium was assessed using the Confusion Assessment Method.

MEASUREMENTS AND MAIN

RESULTS

Of the 508 randomized patients, 497 were included in the final analysis. Postoperative delirium occurred in 9 of 247 patients (3.6%) in the intervention group and in 23 of 250 patients (9.2%) in the control group. Bundle perianesthetic management was associated with a significantly lower risk of delirium, both in per-protocol analysis (relative risk 0.40, 95% confidence interval 0.19-0.84, p = 0.012) and intention-to-treat analysis (relative risk 0.39, 95% confidence interval 0.19-0.84, p = 0.011). No significant differences were observed between the groups in terms of delirium duration, postoperative pain, ability to perform activities of daily living, hospitalization duration, or hospital-related costs.

CONCLUSIONS

The findings support integrating this bundle into perioperative pathways to reduce the risk of delirium after thoracic surgery. Further studies are warranted to evaluate its feasibility, generalizability, and safety in broader clinical settings.