Conference Coverage

Postoperative Pain Linked to Greater Delirium Severity in Adults >70

Edited by:
Ashton L. Stahl

Key Highlights

  • The analysis included 140 adults older than 70 years undergoing elective inpatient noncardiac surgery under general anesthesia.
  • Greater postoperative day 1 pain intensity was associated with higher delirium severity after adjustment for cognition, age, anesthesia duration, and frailty.
  • Higher baseline cognitive scores were associated with lower delirium severity, while longer anesthesia duration was associated with greater severity.

Greater pain intensity on postoperative day 1 was independently associated with more severe delirium during the first 3 postoperative days in older surgical patients, according to a secondary analysis of the TIVA-GAS randomized controlled trial. Each 1-unit increase in pain intensity was associated with 21% higher odds of being in a higher delirium severity category.

The findings are scheduled for presentation on October 18 at the ANESTHESIOLOGY Annual Meeting 2026 in San Diego. Investigators examined delirium severity rather than its presence or absence, seeking to better characterize its relationship with postoperative pain.

The single-center analysis included 140 adults older than 70 years undergoing elective inpatient noncardiac surgery under general anesthesia at Oregon Health & Science University. Participants with diagnosed dementia, Parkinson’s disease, psychiatric illness, or missing postoperative day 1 pain assessments were excluded. Pain intensity was measured using the PROMIS-Preference 24-hour average pain intensity item.

Researchers assessed delirium twice daily on postoperative days 1–3 using the 3D-CAM-S, with the maximum score serving as the primary outcome. Scores were grouped into 5 ordered categories: none (0), low (1), moderate (2), high (3), and very high (≥4). An ordinal logistic regression model adjusted for baseline Montreal Cognitive Assessment (MoCA) score, age, anesthesia duration, and frailty.

Study Findings

Greater postoperative day 1 pain intensity was associated with a higher delirium severity category (OR, 1.21; 95% CI, 1.07–1.36; P = .003). This estimate represented the association per 1-unit increase in pain intensity after adjustment for the specified covariates.

Each 1-point increase in baseline MoCA score was associated with lower odds of greater delirium severity (OR, 0.78; 95% CI, 0.69–0.88; P < .001). Each additional 30 minutes of anesthesia was associated with higher odds of greater severity (OR, 1.14; 95% CI, 1.06–1.23; P = .001). Age and frailty were not independently associated in the model.

Clinical Implications

According to the investigators, the findings identify an independent association between greater day 1 pain intensity and increased delirium severity in older adults undergoing elective noncardiac surgery. The authors’ conclusion reflects an adjusted association; the abstract does not report whether a pain-reduction intervention changed delirium severity.

Expert Commentary

“Greater postoperative day 1 pain intensity was independently associated with increased delirium severity in older adults undergoing elective non-cardiac surgery after adjusting for known confounders,” the researchers concluded.

Reference

Howell M, McElheran K, Swanson A, Lee B, Riedman T, Schenning K. Acute postoperative pain severity is associated with increased postoperative delirium severity in older adults. Abstract scheduled for presentation at: Anesthesiology 2026; October 16–20, 2026; San Diego, CA. Abstract A1436.