Ibuprofen and other NSAIDs may reduce the risk of postoperative delirium.
This is according to a study presented at last year’s ANESTHESIOLOGY® 2024 annual meeting.
Steven M Frank, co-author of the study and a professor in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins University, Baltimore, US, said: ‘Postoperative delirium is a serious complication associated with a risk for health problems and even death after surgery. Anaesthesiologists use several methods to try to prevent this complication, and our research shows that a simple intervention such as giving patients an NSAID could be another very effective option.’
Postoperative delirium occurs in up to 15% of surgical patients. In certain high-risk patients, such as those with hip fractures, the incidence can be even higher.
It is a significant complication in older adults. Pain, age, stress, anxiety and insomnia are known contributors to the risk for postoperative delirium.
In the study, researchers analysed an extensive medical records database to identify patients who had surgery with anaesthesia between 2014 and 2023.
The researchers grouped patients by age (18-64 and 65 or older) and the medications they received – acetaminophen only, salicylate NSAIDs only (aspirin), and non-salicylate NSAIDs (ibuprofen, ketorolac or celecoxib) only – and compared their rates of delirium over seven days after surgery.
Patients received the medications orally or intravenously on the day of surgery, before or during the procedure.
For both age groups, non-salicylate NSAIDs lowered the risk of delirium when compared to acetaminophen and salicylate NSAIDs.
For patients aged 18 to 64:
• The non-salicylate NSAIDs versus acetaminophen comparison included 210,678 patients, with 105,339 patients in each group. Overall, patients in this age group who were given non-salicylate NSAIDs had a 22% lower risk for postoperative delirium than those given acetaminophen.
• The non-salicylate NSAIDs versus salicylate NSAIDs comparison included 32,538 patients, 16,269 in each group. Overall, patients in this age group who were given non-salicylate NSAIDs had a 70% lower risk for postoperative delirium than those given salicylate NSAIDs.
For patients aged 65 or older:
• The non-salicylate NSAIDs vs acetaminophen comparison included a total of 72,130 patients, with 36,065 patients in each group. Overall, patients in this age group who were given non-salicylate NSAIDs had a 33% lower risk for postoperative delirium than those given acetaminophen.
• The comparison between the non-salicylate NSAIDs and salicylate NSAIDs included 24,960 patients, with 12,480 in each group. Overall, patients in this age group who were given non-salicylate NSAIDs had a 45% lower risk for postoperative delirium than those given salicylate NSAIDs.
Dr Frank added: ‘Recent studies show acetaminophen helps reduce the risk of postoperative delirium, but our study is the largest to show non-salicylate NSAIDs like ibuprofen could be even better at reducing this risk.
‘Our findings suggest that using a non-salicylate NSAID may make surgical procedures safer by reducing postoperative delirium, possibly by using fewer opioids. Although additional research should be done on this topic, our findings are promising.’
Dr Frank noted that all NSAIDs may have side effects, including nausea and vomiting, impaired kidney function, and an increased risk of bleeding or excessive clotting during surgery.
As such, this may outweigh the benefit for those at the lowest risk for postoperative deliria, such as younger patients.
Assessing a patient’s overall health and risk factors before using NSAIDs to reduce postoperative delirium was a must, he added.
