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Preoperative Acute Pain Is Associated with Postoperative Delirium.

  • Ding, Xian1
  • Gao, Xiang2
  • Chen, Qizhong3
  • Jiang, Xuliang4
  • Li, Yi5
  • Xu, Jingjing6
  • Qin, Guowei6
  • Lu, Shunmei6
  • Huang, Dongxiao7
  • 1 Department of Anesthesiology, The Affiliated Hospital of Jiangnan University (Original Department at Wuxi Third People's Hospital), Wuxi, Jiangsu, China. , (China)
  • 2 Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, China. , (China)
  • 3 Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China. , (China)
  • 4 Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. , (China)
  • 5 Math and Statistics School of Nanjing Audit University, Nanjing, Jiangsu, China. , (China)
  • 6 Department of Anesthesiology, Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China. , (China)
  • 7 The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China. , (China)
Published Article
Pain medicine (Malden, Mass.)
Publication Date
Feb 04, 2021
DOI: 10.1093/pm/pnaa314
PMID: 33040141


Studies have provided some evidence that pain is a risk factor for postoperative delirium (POD). Therefore, we investigated the relationship between preoperative pain and POD after noncardiac surgery. POD was assessed with the Montreal Cognitive Assessment, and preoperative cognition was assessed with the Mini-Mental State Examination. Plasma C-reactive protein (CRP) was detected by enzyme-linked immunosorbent assay before surgery. Preoperative pain was classified by its duration before surgery as chronic pain (lasting more than 1 month), acute pain (lasting less than 1 month), or no pain (no obvious pain). Multiple linear regression was used to adjust for confounding. From October 15, 2018, through August 12, 2019, a total of 67 patients were randomized; 7 were excluded because they were discharged before the seventh postoperative day. The prevalence of POD was significantly higher in the acute pain group (13 of 20; 65%) than in the chronic pain group (5 of 20; 25%) or the no pain group (6 of 20; 30%) (P = 0.019), indicating that delirium is associated with preoperative acute pain. The plasma level of preoperative CRP was also higher in the acute pain group than in the other two groups (mean [interquartile range]: 10.7 [3.3, 29.3] vs 1 [0.5, 3.8]mg/l; P < 0.001), suggesting that elevated preoperative plasma levels of CRP were associated with delirium. Preoperative acute pain was associated with POD, and increased plasma levels of CRP provide a marker. In addition, we found that illiteracy and advanced age were risk factors for POD. © The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected]

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