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Vasopressor Selection and Postoperative Delirium in Older Adults: A Propensity-Matched Database Analysis
Tiffany Dong1, William Mao1, Christopher Baker2
1School of Medicine, University of California Riverside, Riverside, CA, USA.
Seminars in Cardiothoracic and Vascular Anesthesia
|June 26, 2026
Summary
The choice of vasopressors like phenylephrine and ephedrine may impact postoperative delirium rates in older adults. Phenylephrine showed a slightly higher delirium risk compared to ephedrine, suggesting careful vasopressor selection is important.
Area of Science:
- Anesthesiology
- Geriatric Medicine
- Pharmacology
Background:
- Vasopressor selection may influence postoperative delirium by affecting end-organ perfusion.
- Postoperative delirium is a significant concern in older surgical patients.
Purpose of the Study:
- To compare the incidence of postoperative delirium following perioperative administration of phenylephrine, ephedrine, or norepinephrine.
- To investigate the association between different vasopressors and neurocognitive outcomes in elderly surgical patients.
Main Methods:
- Retrospective, propensity-score matched multicenter database study.
- Included patients aged 60 and older undergoing various surgeries.
- Analyzed postoperative delirium rates within seven days of surgery based on ICD-10 codes.
Main Results:
- No significant difference in delirium rates between phenylephrine and norepinephrine (OR 0.97; 95% CI 0.61-1.54).
- No significant difference in delirium rates between ephedrine and norepinephrine (OR 0.74; 95% CI 0.41-1.32).
- Phenylephrine was associated with a higher delirium rate compared to ephedrine (OR 1.30; 95% CI 1.05-1.60; P = .0162), with a small absolute risk difference.
Conclusions:
- Vasopressor choice can influence postoperative neurocognitive outcomes in older adults.
- Further research into the mechanisms of vasopressor-induced delirium may guide clinical practice.
- Individualized intraoperative management considering vasopressor effects could reduce delirium risk.
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