Evidence map›Paper›PMID 39998621›Full record

ArticleJournal of anesthesia2025

The effect of delirium on the association between frailty and postoperative major complications in elderly patients: a mediation analysis.

Ya-Fei Liu, Fan Cui, Xian Su, Ya-Wei Li, Yan Zhang, Chun-Jing Li, Dong-Liang Mu, Dong-Xin Wang

Abstract read
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In one paragraph

Article in Journal of anesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Ya-Fei LiuThe Department of Anesthesiology, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China.
Fan CuiThe Department of Anesthesiology, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China.
Xian SuThe Department of Anesthesiology, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China.
Ya-Wei LiThe Department of Anesthesiology, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China.
Yan ZhangThe Department of Anesthesiology, Peking University Cancer Hospital, Beijing, China.
Chun-Jing Li *The Department of Anesthesiology, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China. gogolion02@bjmu.edu.cn.
Dong-Liang Mu *The Department of Anesthesiology, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China. mudongliang@bjmu.edu.cn.ORCID http://orcid.org/0000-0003-1092-9473
Dong-Xin WangThe Department of Anesthesiology, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China.

Funding

High-level Hospital Construction Project of Guangdong Provincial People's Hospital 2022CR74Key Technologies Research and Development Program 2023YFC2506900National High Level Hospital Clinical Research Funding (Interdepartmental Clinical Research Project of Peking University First Hospital) 2023IR30National Natural Science Foundation of China 82293644Natural Science Foundation of Beijing Municipality 7234391
6 · The paper itself

Abstract

purposeBoth preoperative frailty and postoperative delirium (POD) are associated with higher risk of postoperative complications. But it is unclear if the effect of preoperative frailty on postoperative complications was mediated by POD.

methodsThis study was a mediation analysis of a pooled database. Patients aged ≥ 60 years who underwent elective non-cardiac surgery were enrolled. Preoperative frailty was defined as the modified frailty index (mFI) ≥ 0.27. POD was assessed twice daily within the first 3 days using the Confusion Assessment Method (CAM) for patients without intubation and the CAM for intensive care unit (CAM-ICU) for intubated patients. Major complications within postoperative 30 days were screened. Mediation analysis was employed to explore the relationships between frailty, POD, and postoperative complications.

resultsA total of 4684 patients were included. The prevalence of frailty was 10.4% (489/4684). In comparison with non-frail patients, frail patients had a higher incidence of POD (12.7% [62/489] vs 6.5% [271/4195], RR = 2.102, 95% CI 1.568-2.819, P < 0.001) and more postoperative complications (21.5% [105/489] vs 16.7% [701/4195], RR = 1.363, 95% CI 1.082-1.716, P = 0.008). The adjusted total and direct associations between frailty and postoperative complications were 5.8% (adjusted β, 95% CI, 1.8-9.5%; P < 0.001) and 5.0% (adjusted β, 95% CI, 1.1-8.7%; P = 0.004), respectively. A significant indirect association via POD was observed (adjusted β = 0.8%; 95% CI, 0.3-1.4%; P < 0.001), accounting for 13.8% of the total effect.

conclusionPreoperative frailty is associated with an increased risk of postoperative complications, mediated in part by early POD, in elderly patients following non-cardiac surgery. Given the modest effect size, further research is warranted to confirm these findings.

Indexed as

DeliriumFrailtyPostoperative ComplicationsAgedAged, 80 and overElective Surgical ProceduresFemaleFrail ElderlyGeriatric AssessmentHumansIncidenceMaleMediation AnalysisMiddle AgedRisk FactorsElder patientsFrailtyMediation analysisPostoperative complicationsPostoperative delirium

Identifiers

PMID39998621

What Socratic holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.