Home › Research › Clinical safety
Intraoperative hypotension and postoperative delirium among older high-risk patients undergoing major noncardiac surgery: a retrospective single-centre cohort study
Inaame Ettoumi, Daniel D. Pearce, Theodora Wingert, Amélie Delaporte, Brenton S. Alexander, Ravi Dutt Pal, Jason Hieu Tang, Nancy M. Boulos et al.. BJA Open, 2025-10-15
Topic: Risk, prevention and care in population studies
Background Intraoperative hypotension has been associated with postoperative complications, but its relationship with postoperative delirium remains debated. Methods This single-centre retrospective cohort study included adults (≥60 yr) with ASA physical status score of 3 or 4 undergoing major noncardiac surgery, with documented Confusion Assessment Method assessments. Patients with a history of neurosurgery, stroke, dementia, or neurocognitive disorders were excluded. The primary exposure was the cumulative duration of a mean arterial pressure <65 mm Hg (minutes). The primary outcome was postoperative delirium within 7 days, diagnosed via Confusion Assessment Method. Multivariable logistic regression was used to assess the association between intraoperative hypotension and delirium, adjusting for confounders. Results Among 5171 patients included from 2013–2024, 632 (11.8%) developed delirium. The median (Q1–Q3) duration of surgery and time with mean arterial pressure <65 mm Hg were 281 (199–430) min and 28 (9–61) min, respectively. In models adjusted for patient characteristics and perioperative factors, intraoperative hypotension was associated with increased odds of delirium (odds ratio per 60 min, 1.12; 95% confidence interval, 1.01–1.24; P =0.038). However, after adjusting for year of surgery, the association was attenuated and no longer statistically significant (odds ratio, 1.06; 95% confidence interval, 0.95–1.18; P =0.320). Both intraoperative hypotension exposure and delirium incidence declined significantly over the study period. Conclusions Although intraoperative hypotension initially appeared to be associated with postoperative delirium, this association was no longer significant when accounting for temporal improvements in perioperative care. Intraoperative hypotension may represent a marker of historical practice patterns rather than an independent causal driver of delirium.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Ettoumi, I., Pearce, D. D., Wingert, T., Delaporte, A., Alexander, B. S., Pal, R. D., et al. (2025). Intraoperative hypotension and postoperative delirium among older high-risk patients undergoing major noncardiac surgery: a retrospective single-centre cohort study. BJA Open. https://doi.org/10.1016/j.bjao.2025.100500
Vancouver
Ettoumi I, Pearce DD, Wingert T, Delaporte A, Alexander BS, Pal RD, et al. Intraoperative hypotension and postoperative delirium among older high-risk patients undergoing major noncardiac surgery: a retrospective single-centre cohort study. BJA Open. 2025. doi:10.1016/j.bjao.2025.100500. PMID: 41142588.
BibTeX
@article{ettoumi2025-41142588,
author = {Ettoumi, Inaame and Pearce, Daniel D. and Wingert, Theodora and Delaporte, Amélie and Alexander, Brenton S. and Pal, Ravi Dutt and Tang, Jason Hieu and Boulos, Nancy M. and others},
title = {{Intraoperative hypotension and postoperative delirium among older high-risk patients undergoing major noncardiac surgery: a retrospective single-centre cohort study}},
journal = {BJA Open},
year = {2025},
doi = {10.1016/j.bjao.2025.100500},
pmid = {41142588},
url = {https://doi.org/10.1016/j.bjao.2025.100500}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
Key findings
- Background Intraoperative hypotension has been associated with postoperative complications, but its relationship with postoperative delirium remains debated.
- Results Among 5171 patients included from 2013–2024, 632 (11.8%) developed delirium.
- In models adjusted for patient characteristics and perioperative factors, intraoperative hypotension was associated with increased odds of delirium (odds ratio per 60 min, 1.12; 95% confidence interval, 1.01–1.24; P =0.038).
- However, after adjusting for year of surgery, the association was attenuated and no longer statistically significant (odds ratio, 1.06; 95% confidence interval, 0.95–1.18; P =0.320).
- Both intraoperative hypotension exposure and delirium incidence declined significantly over the study period.
Why it matters
In this retrospective cohort of 5171 older surgical patients, intraoperative hypotension was associated with increased odds of postoperative delirium, but the association was no longer statistically significant after adjusting for year of surgery. It is about a possible risk factor for delirium after surgery, not about treating, curing or preventing Alzheimer's disease.
Study details
- Study designcohort study
- Participants5,171
- Effect size11.8%
- Evidence strengthModerate
How this study scored 55/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (BJA Open) |
| Journal's citation record | 0 / 4 | BJA Open: journal h-index 18 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 3 / 4 | 5,171 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 4 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 3.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 4 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Alexandre Joosten: h-index 28 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of California, Los Angeles: institution h-index 1,923 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41142588) |
| Free to read | 2 / 2 | Free to read |
| Total | 55 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here.
Related studies in Clinical safety
Also tagged “palliative”
858 studies in the library carry the topic tag “palliative”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 858 tagged studies.