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Purpose <p>Postoperative delirium (POD) is a common complication in elderly surgical patients, associated with increased mortality and healthcare costs. While high-dose steroids may reduce POD risk in non-cardiac surgeries, infection concerns limit their use. This study assessed whether intraoperative low-dose steroids, commonly used as antiemetics, are associated with lower POD incidence.</p> Methods <p>We conducted a retrospective cohort study of patients aged 65 or older who underwent elective non-cardiac surgery at Cleveland Clinic from 2016 to 2024. Patients receiving intraoperative steroids (4–10&#xa0;mg dexamethasone) were compared to those who did not. Primary outcome was POD within 4&#xa0;days postoperatively; secondary outcomes included hospital length of stay and infection complications. Logistic and linear regression models were used and adjusted for potential confounders. Additionally, a sensitivity analysis was conducted to examine the interaction between steroids and dementia.</p> Results <p>Among 46,966 patients, 59% received steroids. POD incidence was significantly lower in the steroid administration group (0.6%) versus controls (2.2%) [adjusted odds ratio (aOR): 0.33, 95% confidence interval (CI): 0.25–0.42, <i>P</i> &lt; 0.001], a finding that remained consistent under broader POD definitions (5.1% vs. 8.9%; aOR = 0.76, 95% CI 0.69–0.84, <i>P</i> &lt; 0.001). The benefit was evident in patients without dementia (aOR: 0.73) but not in those with dementia (aOR: 1.18). Steroid administration was also linked to shorter hospital stays (adjusted geometric mean ratio: 0.90, <i>P</i> &lt; 0.001) and fewer postoperative infections (aOR: 0.43, <i>P</i> &lt; 0.001).</p> Conclusions <p>Intraoperative steroid administration was associated with reduced POD, shorter hospital stays, and fewer infections in elderly patients undergoing elective non-cardiac surgery. These findings support their perioperative use, particularly in patients without preexisting dementia.</p>

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The effect of intravenous low-dose steroids on post-operative delirium in older adult patients undergoing non-cardiac surgery: a retrospective cohort analysis

  • 期刊论文

  • 发表日期：

    2026年7月30日

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  • Huan Hsu,
  • Yara Dias,
  • Yi-Wen Chang,
  • Junhui Mi,
  • Liu Liu,
  • Ahmad Al Jarkas,
  • Sam D. Gumbert,
  • Jiang Wu,
  • Yian Chen,
  • Ryu Komatsu

摘要

Purpose

Postoperative delirium (POD) is a common complication in elderly surgical patients, associated with increased mortality and healthcare costs. While high-dose steroids may reduce POD risk in non-cardiac surgeries, infection concerns limit their use. This study assessed whether intraoperative low-dose steroids, commonly used as antiemetics, are associated with lower POD incidence.

Methods

We conducted a retrospective cohort study of patients aged 65 or older who underwent elective non-cardiac surgery at Cleveland Clinic from 2016 to 2024. Patients receiving intraoperative steroids (4–10 mg dexamethasone) were compared to those who did not. Primary outcome was POD within 4 days postoperatively; secondary outcomes included hospital length of stay and infection complications. Logistic and linear regression models were used and adjusted for potential confounders. Additionally, a sensitivity analysis was conducted to examine the interaction between steroids and dementia.

Results

Among 46,966 patients, 59% received steroids. POD incidence was significantly lower in the steroid administration group (0.6%) versus controls (2.2%) [adjusted odds ratio (aOR): 0.33, 95% confidence interval (CI): 0.25–0.42, P < 0.001], a finding that remained consistent under broader POD definitions (5.1% vs. 8.9%; aOR = 0.76, 95% CI 0.69–0.84, P < 0.001). The benefit was evident in patients without dementia (aOR: 0.73) but not in those with dementia (aOR: 1.18). Steroid administration was also linked to shorter hospital stays (adjusted geometric mean ratio: 0.90, P < 0.001) and fewer postoperative infections (aOR: 0.43, P < 0.001).

Conclusions

Intraoperative steroid administration was associated with reduced POD, shorter hospital stays, and fewer infections in elderly patients undergoing elective non-cardiac surgery. These findings support their perioperative use, particularly in patients without preexisting dementia.