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| Item Type: | Article |
|---|---|
| Title: | Prediction and risk evaluation of delirium after surgery in older patients: development and internal validation of an algorithm from the prospective BioCog cohort study |
| Creators: |
Lammers-Lietz, Florian  ORCID: https://orcid.org/0000-0002-7371-3947, Akyuez, Levent, Boraschi, Diana ORCID: https://orcid.org/0000-0002-3953-4056, Borchers, Friedrich ORCID: https://orcid.org/0000-0001-7290-2271, de Bresser, Jeroen ORCID: https://orcid.org/0000-0003-0759-8407, Chatterjee, Sreyoshi, Correia, Marta M. ORCID: https://orcid.org/0000-0002-3231-7040, de Lange, Nikola M., Dschietzig, Thomas Bernd, Ghosh, Soumyabrata ORCID: https://orcid.org/0000-0003-0659-6733, Feinkohl, Insa ORCID: https://orcid.org/0000-0002-0307-1862, Ferreira da Silva, Izabela, Fislage, Marinus, Fournier, Anna ORCID: https://orcid.org/0000-0002-5417-4001, Gallinat, Jürgen, Hadzidiakos, Daniel, Hädel, Sven ORCID: https://orcid.org/0009-0009-8565-3425, Halzl-Yürek, Fatima, Heilmann-Heimbach, Stefanie ORCID: https://orcid.org/0000-0003-1057-465X, Heinrich, Maria, Hendrikse, Jeroen, Hoffmann, Per ORCID: https://orcid.org/0000-0002-6573-983X, Janke, Jürgen ORCID: https://orcid.org/0000-0003-0113-4118, Kant, Ilse M.J., Kraft, Angelie ORCID: https://orcid.org/0000-0002-2980-952X, Krause, Roland ORCID: https://orcid.org/0000-0001-9938-7126, Kruppa-Scheetz, Jochen, Kühn, Simone, Lachmann, Gunnar ORCID: https://orcid.org/0000-0003-2330-9839, Laubach, Markus ORCID: https://orcid.org/0000-0002-3451-1445, Lippert, Christoph ORCID: https://orcid.org/0000-0001-6363-2556, Menon, David K. ORCID: https://orcid.org/0000-0002-3228-9692, Mörgeli, Rudolf ORCID: https://orcid.org/0000-0001-8506-5898, Müller, Anika ORCID: https://orcid.org/0000-0002-6859-7080, Mutsaerts, Henk-Jan ORCID: https://orcid.org/0000-0003-0894-0307, Nöthen, Markus, Nürnberg, Peter ORCID: https://orcid.org/0000-0002-7228-428X, Ofosu, Kwaku, Pietzsch, Malte ORCID: https://orcid.org/0000-0002-6686-9839, Piper, Sophie K. ORCID: https://orcid.org/0000-0002-0147-8992, Pischon, Tobias ORCID: https://orcid.org/0000-0003-1568-767X, Preller, Jacobus ORCID: https://orcid.org/0000-0001-5706-816X, Scheurer, Konstanze, Schneider, Reinhard, Scholtz, Kathrin, Schreier, Peter H., Slooter, Arjen J.C., Stamatakis, Emmanuel A. ORCID: https://orcid.org/0000-0001-6955-9601, von Haefen, Clarissa, van Montfort, Simone J.T., van Dellen, Edwin, Volk, Hans-Dieter, Weber, Simon, Wiebach, Janine, Wiehe, Anton ORCID: https://orcid.org/0009-0009-9021-1955, Winterer, Jeanne M., Wolf, Alissa, Zacharias, Norman ORCID: https://orcid.org/0000-0001-5794-5716, Spies, Claudia and Winterer, Georg
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| Abstract: | BACKGROUND: Postoperative delirium (POD) affects ∼20% of older surgical patients. It is associated with poor clinical outcome and increased mortality. We aimed to identify the major POD risk factors and to develop and validate a multivariate algorithm for individual POD risk prediction and risk evaluation in the very early postoperative period. METHODS: BioCog is a prospective cohort study conducted in the anaesthesiology departments of two tertiary care centres in Germany and The Netherlands. Patients aged ≥65 yr with no preoperative dementia (Mini-Mental Status Examination ≥24) undergoing surgery with an expected duration of at least 60 min were enrolled and screened for POD according to DSM 5 until the seventh postoperative day. Clinical, neuropsychological, neuroimaging data, and blood were measured before and after surgery. We evaluated several models by sequentially adding blocks of variables. Gradient-boosted trees (GBT) with nested cross-validation were used for POD prediction. Model accuracy (area under the receiver-operating curve, AUC) and calibration were assessed (Brier score). RESULTS: Out of 929 patients, 184 (20%) experienced POD. A GBT algorithm using both preoperative data, characteristics of the intervention, and postoperative changes in laboratory parameters achieved the highest AUC (0.83, [0.79-0.86]) with a Brier score of 0.12 (0.12-0.13). CONCLUSIONS: Models combining preoperative with precipitating factors during surgery predict POD with high accuracy. This suggests that the resulting algorithms eventually may become useful to support clinical decision-making. CLINICAL TRIAL REGISTRATION: NCT02265263. |
| Keywords: | Cohort Study, Neuroimaging, Postoperative Complications, Postoperative Delirium, Risk Factors, Transcriptome |
| Source: | British Journal of Anaesthesia |
| ISSN: | 0007-0912 |
| Publisher: | Elsevier |
| Volume: | 136 |
| Number: | 5 |
| Page Range: | 1495-1508 |
| Date: | May 2026 |
| Official Publication: | https://doi.org/10.1016/j.bja.2026.01.025 |
| PubMed: | View item in PubMed |
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