EVALUATING THE EFFECTS OF GENERAL ANESTHESIA ON POSTOPERATIVE DELIRIUM IN PATIENTS UNDERGOING SURGERY AT DHQ LAKKI MARWAT: A CROSS-SECTIONAL STUDY

Abstract

Background: Postoperative delirium (POD) is one of the most frequent and serious neurocognitive complications observed after surgery, especially among patients receiving general anesthesia. It manifests as an acute disturbance in attention and cognition, contributing to increased morbidity, prolonged hospital stay, and elevated healthcare costs. Despite its clinical significance, postoperative delirium remains under-recognized in many regional hospitals in Pakistan, where standardized screening and preventive protocols are limited.

Objective: This study aimed to evaluate the effects of general anesthesia on the development of postoperative delirium and to identify associated demographic, clinical, and anesthetic risk factors among surgical patients at District Headquarters (DHQ) Hospital, Lakki Marwat.

Methods: A descriptive cross-sectional study was conducted on 177 adult patients who underwent surgery under general anesthesia. Data were collected using a structured questionnaire and the Confusion Assessment Method (CAM) to assess delirium within 24–72 hours postoperatively. Collected variables included age, gender, ASA classification, type and duration of surgery, comorbidities, cognitive status, and ICU admission. Statistical analysis was performed using SPSS version 25. Descriptive statistics were used to summarize data, chi-square tests identified associations, and binary logistic regression determined independent predictors of postoperative delirium, with statistical significance set at p < 0.05.

Results: Postoperative delirium was identified in 19.2% (n = 34) of the 177 patients. Delirium was significantly more frequent among patients aged ≥65 years (50.0%), those with ASA class III–IV (67.6%), emergency surgeries (50.0%), and prolonged anesthesia duration exceeding 4 hours (38.3%). Preexisting cognitive impairment (32.4%), comorbidities (79.4%), and ICU admission (38.2%) were also significantly associated (p < 0.05). Logistic regression analysis revealed preexisting cognitive impairment (OR = 4.32), prolonged anesthesia (OR = 3.43), and advanced age (OR = 2.61) as independent predictors. The model exhibited good fit with a Nagelkerke R² of 0.41 and 84.2% overall accuracy.

Conclusion: Postoperative delirium is a relatively common complication following general anesthesia, particularly in elderly and medically compromised patients. Identification of high-risk individuals, optimization of preoperative status, and vigilant intraoperative and postoperative monitoring are crucial in reducing its incidence and improving recovery outcomes.