Duration of Intraoperative Cerebral Oxygen Desaturation and Postoperative Delirium in Elderly Patients Undergoing Major Noncardiac Surgery: A Prospective Observational Study.

Authors

Jinben Ma, Yu Wang, Zhifei Liu, Shaoxian Han

Published in

Journal of cardiothoracic and vascular anesthesia. Aug 01, 2026. Epub Aug 01, 2026.

Abstract

To investigate whether the cumulative duration of a clinically significant decline in regional cerebral oxygen saturation (rSO₂) independently predicts postoperative delirium (POD) in elderly patients undergoing major noncardiac surgery.
Single-center prospective observational study.
Hospital surgical department (tertiary care center, implied from the design).
A total of 347 patients age 65 years or older undergoing major noncardiac procedures, after excluding those with preexisting delirium, incomplete monitoring data, or reoperations.
Bilateral cerebral near-infrared spectroscopy was used to continuously monitor rSO₂ from anesthetic induction to surgical closure. The primary exposure was the total duration (minutes) of rSO₂ decline ≥20% from individual preinduction baseline. No specific intraoperative intervention to treat desaturation was mandated by the study protocol.
POD was assessed twice daily for 5 postoperative days using the Confusion Assessment Method. POD occurred in 83 of 347 patients (23.9%). In multivariable logistic regression, each additional minute of rSO₂ decline ≥20% was associated with a 5% increase in the odds of POD (adjusted odds ratio [aOR], 1.05; 95% confidence interval [CI] 1.01-1.09; p = 0.012). Other independent predictors included age (aOR, 1.09), preoperative Mini-Mental State Examination score (aOR, 0.79), and surgical duration (aOR, 1.01). The full model's area under the curve was 0.743; adding rSO₂ decline duration yielded a category-free net reclassification improvement of 0.207 (p = 0.038).
Prolonged intraoperative cerebral oxygen desaturation is independently associated with POD in elderly noncardiac surgical patients. Continuous rSO₂ monitoring may help identify patients at elevated risk who could benefit from targeted perioperative neuroprotective strategies.

PMID:
42637590
Bibliographic data and abstract were imported from PubMed on 25 Aug 2026.

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