Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce patients’ risk of postoperative delirium, according to a study presented at ANESTHESIOLOGY® Annual meeting 2024.
Postoperative delirium is a serious complication associated with a risk of health problems and even death after surgery. Anesthesiologists use several methods to prevent this complication, and our research shows that a simple intervention, such as giving patients an NSAID, could also be a highly effective option.”
Steven M. Frank, MD, co-author of the study and professor, Department of Anesthesiology and Critical Care Medicine at Johns Hopkins University, Baltimore
Postoperative delirium is a change in mental function that can cause confusion and occurs in up to 15% of surgical patients. In certain high-risk patients, such as patients with hip fractures, the incidence may be even higher. It is a major complication in older adults. Pain, age, stress, anxiety and insomnia are known to contribute to the risk of postoperative delirium.
In the study, researchers analyzed a large database of medical records to identify patients who had undergone surgery with anesthesia between 2014 and 2023. The researchers grouped patients by age (18-64 and 65 years or older) and the medications they received -; paracetamol only, salicylate NSAIDs only (e.g. aspirin) and non-salicylate NSAIDs only (e.g. ibuprofen, ketorolac or celecoxib) -; and compared their delirium rates over a seven-day period after surgery. Patients received the medications orally or intravenously on the day of surgery, before or during the procedure. For both age groups, non-salicylate NSAIDs reduced the risk of delirium compared with acetaminophen and salicylate NSAIDs.
For patients aged 18 to 64:
- The comparison of non-salicylate NSAIDs versus acetaminophen included a total of 210,678 patients, with 105,339 patients in each group. Overall, patients in this age group who received non-salicylate NSAIDs had a 22% lower risk of postoperative delirium than those who received acetaminophen.
- The comparison of non-salicylate NSAIDs versus salicylate NSAIDs involved a total of 32,538 patients, with 16,269 patients in each group. Overall, patients in this age group who received non-salicylate NSAIDs had a 70% lower risk of postoperative delirium than those who received salicylate NSAIDs.
For patients 65 years or older:
- The comparison of non-salicylate NSAIDs versus acetaminophen involved a total of 72,130 patients, with 36,065 patients in each group. Overall, patients in this age group who received non-salicylate NSAIDs had a 33% lower risk of postoperative delirium than those who received acetaminophen.
- The comparison of non-salicylate NSAIDs versus salicylate NSAIDs involved a total of 24,960 patients, with 12,480 patients in each group. Overall, patients in this age group who received non-salicylate NSAIDs had a 45% lower risk of postoperative delirium than those who received salicylate NSAIDs.
“Recent studies show that acetaminophen helps reduce the risk of postoperative delirium, but our study is the largest and shows that non-salicylate NSAIDs such as ibuprofen could be even better at reducing this risk,” said Dr. Frank. “Our findings suggest that use of a non-salicylate NSAID may make surgical procedures safer by reducing postoperative delirium, possibly through less opioid use. Although additional research should be conducted on this topic, our findings are promising.”
Dr. Frank added that all NSAIDs can have side effects, including nausea and vomiting, decreased kidney function and an increased risk of bleeding or excessive clotting during surgery, which may outweigh the benefits for people at the lowest risk of postoperative delirium, such as younger patients. It is important to assess a patient’s overall health and risk factors before using NSAIDs to reduce postoperative delirium, he said.
Postoperative delirium can significantly impact recovery through healthcare costs, length of hospital stay, and risk of more serious outcomes, such as cognitive decline, dementia, decline in physical function, long-term care facility placement, and death. To reduce these risks, anesthesiologists use a variety of methods, including conducting a pre-surgery assessment to identify high-risk groups and adjust their anesthesia plan as necessary. During surgery, anesthesiologists monitor anesthesia levels to ensure appropriate sedation and use non-opioid pain medications when possible. After the operation, they monitor the patients closely and ensure that they can return to work as quickly as possible. In addition, they talk to the family about how to prevent their loved one from becoming disoriented by being present at their bedside and making sure they have the necessary hearing aids or glasses.