DOI: 10.1177/10892532261465066 ISSN: 1089-2532

Vasopressor Selection and Postoperative Delirium in Older Adults: A Propensity-Matched Database Analysis

Tiffany Dong, William Mao, Christopher Baker, Blake Han, Leonard J. Soloniuk, Gary Stier, Daniel A Novak, Ioana Pasca, Jiapeng Huang
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Objectives

Vasopressor choice potentially contributes to postoperative delirium due to differences in end-organ perfusion. This study seeks to determine the rates of postoperative delirium after perioperative phenylephrine, ephedrine, or norepinephrine administration.

Design

Retrospective, propensity-score matched multicenter database study.

Participants

Patients aged 60 and older undergoing surgery of the integumentary, musculoskeletal, respiratory, hematologic/lymphatic, gastrointestinal, genitourinary/reproductive, endocrine, or sensory organ systems.

Interventions

Perioperative vasopressor administration (phenylephrine, ephedrine, norepinephrine).

Measurements and Main Results

The primary outcome was the incidence of postoperative delirium based on ICD-10 diagnostic codes within seven days of surgery. After propensity score matching, there was no difference in the rate of postoperative delirium between phenylephrine and norepinephrine (OR 0.97; 95% CI 0.61–1.54; P = .9065) or between ephedrine and norepinephrine (OR 0.74; 95% CI 0.41-1.32; P = .3062). Phenylephrine was associated with a higher rate of postoperative delirium when compared to ephedrine (OR 1.30; 95% CI 1.05–1.60; P = .0162), although absolute risk difference was small (0.05%).

Conclusions

This study highlights the potential influence of vasopressor selection on postoperative neurocognitive outcomes in older adults. Understanding the physiologic and pharmacologic mechanisms underlying these associations may help guide individualized intraoperative management and reduce delirium risk in clinical practice.

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