Related Experiment Video
Updated: Sep 10, 2025
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Patient-reported outcomes as drivers of postoperative delirium in the postanaesthesia care unit: Data from a one-year
Joana Berger-Estilita1, Isabel Marcolino, Mia Gisselbaek
1From the Department of Anaesthesiology and Intensive Care, Salem-Spital, Hirslanden Hospital Group, Bern, Switzerland (JB-A, CS, TWB), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), RISE-Health, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (JB-E), Institute of Anaesthesiology and Intensive Care, Spital Limmattal, Schlieren, Switzerland (IM), Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland (MG), Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland (MG), Faculdade de Medicina, Universidade do Porto, Porto, Portugal (IF), Department of Anaesthesia and Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey (BCM), Ankara University Brain Research Center (BAUM), Ankara, Turkey (BCM), Department of Anaesthesia and Intensive Care, Hospital of Nykøbing Falster, University of Southern Denmark, Odense, Denmark (FMR), Department of Anesthesiology, Helora, Mons, Belgium (SS), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS).
Background:
Value-based healthcare emphasises patient-centred outcomes. However, Patient-Reported Outcomes Measures (PROMs) and Patient-Reported Experience Measures (PREMs) remain underused in peri-operative care. Postoperative delirium (POD) is a common and serious complication associated with increased morbidity and healthcare costs. Understanding the prognostic value of PROMs and PREMs may support identification and prevention of POD in the postoperative anaesthesia care unit (PACU).
Objectives:
We assessed the association between peri-operative patient-reported symptoms and PACU POD using systematically collected PROMs and PREMs (including pain, anxiety, thirst, stress, and satisfaction), following the implementation of a brain protection care bundle.
Design:
Prospective cohort study.
Setting:
A single-centre study in a secondary-care private hospital in Switzerland from January 2023 to January 2024.
Patients:
1419 adults undergoing elective or urgent surgery. Exclusion criteria included age <18 years, inability to provide consent, language barriers, need for postoperative mechanical ventilation, or pre-operative Nursing Delirium Screening Scale (Nu-DESC > or equal to 2).
Interventions:
Implementation of the Safe Brain Initiative (SBI) care bundle, incorporating 18 multidisciplinary, nonpharmacologic strategies to optimise peri-operative brain health.
Main Outcome Measures:
The primary outcome was PACU POD incidence, assessed using the Nu-DESC at emergence and PACU discharge. Secondary outcomes included associations between PACU POD and pre-operative PROMs (pain, anxiety, stress, nausea) and PREMs (satisfaction, well being).
Results:
PACU POD occurred in 19.6% of patients. Pre-operative anxiety (NRS > 7) was an independent predictor of POD ( P = 0.012). Pre-operative PROMs showed increasing trends, while postoperative symptoms (pain, anxiety, nausea) significantly decreased. Patients with POD reported lower well being scores despite high satisfaction in other PREM domains.
Conclusions:
Pre-operative anxiety and stress strongly predict PACU POD, supporting early risk stratification and targeted interventions. Integrating PROMs and PREMs into peri-operative workflows enhances patient-centred care.
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