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A Self-administered Preoperative Visual Paired Comparison Task Is Associated With Postanesthesia Care Unit Delirium.

Alexander Papangelou1, Milad Sharifpour2, David W Boorman1

  • 1Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.

Journal of Neurosurgical Anesthesiology
|March 25, 2026
PubMed
Summary

A preoperative visual paired comparison (VPC) task may help identify patients at risk for Postanesthesia Care Unit delirium (PACU-D). Lower VPC scores were associated with developing PACU-D, suggesting a potential predictive tool.

Keywords:
Automated pupillometryPostanesthesia Care Unit deliriumcognitive dysfunctionneurocognitive disordersvisual paired comparison task

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Area of Science:

  • Anesthesiology
  • Neuroscience
  • Gerontology

Background:

  • Postanesthesia Care Unit delirium (PACU-D) is a significant complication.
  • PACU-D increases morbidity, including longer hospital stays and postoperative cognitive dysfunction.
  • Early identification of at-risk patients is crucial for mitigating adverse outcomes.

Purpose of the Study:

  • To investigate the association between preoperative cognitive function tests and the development of PACU-D.
  • To determine if visual paired comparison (VPC) or automated pupillometry can predict PACU-D.
  • To identify potential biomarkers for early detection of postoperative delirium.

Main Methods:

  • Prospective, observational study design.
  • Inclusion of patients undergoing elective surgery under general anesthesia.
  • Preoperative assessment using a 5-minute visual paired comparison (VPC) task and automated pupillometry.
  • Postoperative delirium screening using three scales at 15 and 60 minutes after PACU admission.

Main Results:

  • A significant proportion of patients screened positive for delirium postoperatively.
  • A preoperative VPC score ≤ 0.75 was associated with PACU-D at 60 minutes (P=0.043).
  • Continuous VPC performance showed an association with PACU-D at both 15 and 60 minutes post-admission.
  • Maximum constriction velocity from automated pupillometry was not associated with PACU-D.

Conclusions:

  • A preoperative visual paired comparison (VPC) task may serve as a predictive tool for Postanesthesia Care Unit delirium (PACU-D).
  • Lower VPC scores (< 0.75) indicate a higher risk of developing PACU-D.
  • Automated pupillometry did not demonstrate an association with PACU-D in this cohort.