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Is perioperative hypotension a risk factor for developing postoperative delirium in elderly patients after elective lumbar spine surgery?
Journal article

Is perioperative hypotension a risk factor for developing postoperative delirium in elderly patients after elective lumbar spine surgery?

Andrew Bisenius, Linder Wendt, Patrick Tel Eyck, Elyana Wohl, Yasser El-Hattab, Rashmi N. Mueller and Elena Garrido
Next research, Vol.8, 101591
06/2026
DOI: 10.1016/j.nexres.2026.101591

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Abstract

•There is a lack of studies investigating the association between perioperative hypotension including the Post-Anesthesia Care Unit (PACU) and postoperative delirium in the elderly undergoing lumbar spine surgery.•In our cohort of patients, perioperative hypotension was not associated with increased risk of developing delirium in the first two postoperative days.•Similar to previous reports, we found an association of postoperative delirium with previous cervical spine surgery, low preoperative hemoglobin, increased crystalloid infusion, and uncontrolled pain. Postoperative delirium (POD) is a common complication in the elderly. The specific correlation between intraoperative hypotension and postoperative delirium remains unclear and controversial. We retrospectively analyzed the medical records of 375 elderly patients undergoing elective lumbar spine surgery. The primary endpoint was to determine whether there was an association between perioperative hypotension and POD during the first two postoperative days measured by the Delirium Observation Screening Scale (DOSS). Perioperative hypotension was defined as cumulative minutes of systolic blood pressure (SBP) <100 mm Hg and/or mean arterial pressure (MAP) <60 mm Hg in any of the blood pressure measurements taken in the operating room and Post-anesthesia Care Unit (PACU). Secondarily, we also aimed to investigate other potential risk factors associated with POD in this patient population. Intraoperative hypotension and/or hypotension in the PACU was not associated with POD. Using univariate analyses, we found significant association of postoperative delirium with any previous cervical procedure (p< 0.001), low preoperative hemoglobin (p = 0.048), intensity of pain during the postoperative day 0 (p = 0.006), postoperative day 1 (p< 0.001), postoperative day 2 (p = 0.008), increased crystalloid infusion (p<0.001) and rescue doses of intravenous (IV) morphine given during the postoperative day 2 (p = 0.038). Our results showed no association between perioperative hypotension and early postoperative delirium in elderly patients undergoing elective lumbar spine surgery. We found other risk factors that may require future prospective studies to confirm the strength of association and explore more closely the relationship with the development of POD.
 Lumbar spine surgery Older surgical adults Perioperative hypotension Postoperative delirium

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