• Bing-Yan Cai, Shu-Ting He, Yan Zhang, Jia-Hui Ma, Dong-Liang Mu, and Dong-Xin Wang.
• Department of Anesthesiology, Peking University First Hospital, Beijing, China.
• J Clin Anesth. 2024 Oct 22; 99: 111663111663.

Study ObjectiveTo test the hypothesis that emergence delirium might be associated with worse long-term survival.DesignA longitudinal prospective observational study.SettingA tertiary hospital in Beijing, China.PatientsA total of 942 patients aged 65-90 years who were admitted to post-anesthesia care unit (PACU) after major noncardiac surgery under general anesthesia.ExposuresEmergence delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit during PACU stay.MeasurementsPatients were followed up once a year for at least 3 years. Our primary endpoint was overall survival. Secondary endpoints included recurrence-free and event-free survivals. Associations between emergence delirium and long-term survivals were analyzed with the Cox proportional hazard models.Main ResultsAmong enrolled patients, 915 completed perioperative assessments; 906 completed long-term follow-up (mean age 72 years; 60 % [545/906] male; 73 % [660/906] cancer surgery). At the end of follow-up (median 43 months), there were 69 deaths in 331 patients (21 %) with emergence delirium versus 114 deaths in 575 patients (20 %) without: unadjusted hazard ratio 1.10 (95 % CI: 0.81 to 1.48); P = 0.547; adjusted hazard ratio 0.96 (95 % CI: 0.70 to 1.32); P = 0.797. Recurrence-free survival was 73/331 (22 %) in patients with emergence delirium versus 121/575 (21 %) without: unadjusted hazard ratio 1.08 (95 % CI: 0.81 to 1.45); P = 0.598; adjusted hazard ratio 0.94 (95 % CI: 0.69 to 1.28); P = 0.695. Event-free survival was 159/331 (48 %) in patients with emergence delirium versus 268/575 (47 %) without: unadjusted hazard ratio 1.06 (95 % CI: 0.87 to 1.29); P = 0.563; adjusted hazard ratio 0.98 (95 % CI: 0.80 to 1.21); P = 0.875.ConclusionsWe did not find significant association between emergence delirium and worse long-term survival in older patients after general anesthesia and major surgery mainly for cancer. The effects of emergence delirium on long-term outcomes deserve further investigation.Clinical Trial Registrationswww.chictr.org.cn; ChiCTR-OOC-17012734.Copyright © 2024 Elsevier Inc. All rights reserved.

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