The Effect of Preoperative Medication Intervention on Early Postoperative Cognitive Function in Elderly Patients With...

To investigate the impact of preoperative zolpidem administration on early postoperative cognitive function in elderly patients with poor sleep quality, elderly patients undergoing gastrointestinal surgery with sleep disorders were enrolled and randomly allocated to two groups. The experimental group received 5 mg of oral zolpidem at bedtime for three consecutive nights preoperatively, whereas the control group was given a placebo. Data collected included patients' sleep quality after medication, demographic characteristics, intraoperative parameters, and the incidence of postoperative delirium (POD). Results showed that zolpidem effectively improved preoperative sleep quality in elderly patients. However, the preoperative administration of zolpidem did not yield a statistically significant reduction in the incidence of POD in this cohort, likely attributable to inadequate statistical power. Preoperative zolpidem intervention did not significantly reduce the incidence of POD in this population. Logistic multivariate regression analysis indicated that early POD was correlated with patient age, blood transfusion, postoperative pain, and the frequency of intraoperative hypotensive episodes; however, no significant association was observed between preoperative sleep quality and the recovery of early postoperative cognitive function. In conclusion, preoperative zolpidem intervention can safely and effectively enhance sleep quality in elderly patients undergoing gastrointestinal surgery. However, the observed effect size was smaller than anticipated (Cohen's h = 0.15), and the confidence interval for the difference in delirium incidence included both clinically meaningful benefit and harm. Therefore, we cannot draw definitive conclusions about whether short-term improvement in preoperative sleep quality reduces the incidence of early POD. These findings should be considered exploratory and require validation through larger, adequately powered multicenter prospective studies with objective sleep measures and longer intervention durations.