Impact of Postoperative Delirium on Multidimensional Recovery After Craniotomy: A Prospective Cohort Study

Postoperative delirium (POD) is a frequent complication following neurosurgery, yet research on its specific impact on multidimensional recovery in craniotomy patients is limited. This study aimed to determine the incidence of POD and investigate its impact on physical, psychological, and cognitive recovery at both hospital discharge and the first follow-up visit.

A prospective cohort study was conducted with 164 postcraniotomy patients at a tertiary hospital in Bangkok. POD was assessed 48 to 72 hours postoperatively using the Confusion Assessment Method for the ICU (CAM-ICU). Recovery was evaluated across 3 dimensions: physical (Sickness Impact Profile), psychological (State Anxiety Inventory), and cognitive (Montreal Cognitive Assessment). Multiple regression analysis was used to analyze the impact of CAM-ICU positive, adjusting for surgical duration, postoperative complications, and consciousness levels.

The incidence of CAM-ICU positive was 18.29%. Patients who were CAM-ICU negative demonstrated significantly better physical and cognitive recovery and shorter lengths of stay, although they reported poorer psychological recovery. At the first follow-up, better physical and poorer psychological recovery persisted in the CAM-ICU-negative group, while cognitive recovery no longer differed between groups. After adjusting for confounding variables, CAM-ICU positive was a significant predictor of poorer physical (B=8.218, P=.01) and cognitive (B=-1.545, P<.001) recovery.

POD significantly impairs physical and cognitive recovery in patients following craniotomy. Routine perioperative screening for delirium is essential for neuroscience nurses to identify at-risk patients early and implement interventions to promote recovery across all dimensions.