Background Previous studies have declared that smoking was a risk factor for postoperative delirium (POD), but others have inconsistent results. Up till now, the association between smoking and POD has not been verified. This study investigates the relationship between smoking and POD in patients with pulmonary hypertension (PHTN) in the United States. Methods Patients with PHTN who underwent non-cardiac, non-obstetric surgery were enrolled in the original research completed by Aalap C. et al. We further excluded the patients undergoing intracranial surgery and the patients with sepsis and perioperative stroke to avoid interference with POD assessment. The generalized linear model and generalized additive model were used to explore the relationship between smoking and POD. The propensity score adjustment was used for sensitivity analyses. Results Five hundred thirty-nine patients were included in this study. The overall incidence of POD was 3.0% (16/539). After adjusting the potential confounders (age, systemic hypertension, coronary artery disease, COPD, length of surgery, intrathoracic surgery, vascular surgery), a positive relationship was found between smoking status and POD (OR = 4.53, 95% CI: 1.22 to 16.86, P = 0.0243). In addition, the curvilinear relationship between smoking burden (pack-years) and POD is close to a linear relationship. Conclusion Smoking probably shows a positive correlation with POD in patients with PHTN.

Background: Previous studies have declared that smoking is a risk factor for postoperative delirium (POD), but others have inconsistent results. Up till now, the association between smoking and POD has not been verified. This study aims to investigate the relationship between smoking and POD in patients with pulmonary hypertension (PHTN) in the United States.Methods: This study is a secondary analysis of a retrospective cohort study completed by Aalap C. et al. Patients with PHTN who underwent non-cardiac, non-obstetric surgery were enrolled in the original study. We further excluded the patients undergoing intracranial surgery and the patients with sepsis and perioperative stroke to avoid interference with POD assessment. The generalized linear model and generalized additive model were used to explore the relationship between smoking and POD.Results: After adjusting the potential confounders (age, gender, BMI, poor functional status, PHTN severity, some comorbidities such as hypertension, angina, coronary artery disease, arrhythmia, COPD, asthma, diabetes and renal failure, length of surgery, open surgical approach, intraabdominal surgery, intrathoracic surgery, vascular surgery, some medications such as anticoagulant, antiplatelet, steroids, statin, and atropine, some inhalational anesthesia agent such as isoflurane and sevoflurane), a positive relationship was found between smoking status and POD (OR=5.61, 95% CI: 1.14 to 27.51, P=0.0334). In addition, the curvilinear relationship between smoking burden (pack-years) and POD is close to a linear relationship.Conclusion: Smoking shows a positive correlation with POD in patients with PHTN. Surgical individuals need to prevent POD especially those with a heavy smoking burden.

ObjectiveTo investigate the correlation between preoperative use of ACEIs/ARBs and postoperative delirium (POD) in surgical patients with pulmonary arterial hypertension (PAH).MethodsThe present study is a secondary analysis of a retrospective cohort study conducted at the University of Washington Medical Center from April 2007 to September 2013. Patients with PAH who underwent non-cardiac, non-obstetric surgery were enrolled in the original research. We further excluded stroke, sepsis, and craniotomy patients from interfering with POD evaluation. The univariate regression analysis and multivariate-adjusted model were used to explore the influence of preoperative ACEIs/ARBs use on the occurrence of POD.ResultsA total of 539 patients were included in this study. The incidence of POD in these patients was 3.0%. Following the adjustment of potential confounders (age, BMI, smoking status, pulmonary arterial systolic pressure, length of surgery, vascular surgery, asthma, obstructive sleep apnea, renal failure, atrial fibrillation, coronary artery disease, hydrochlorothiazide, alpha-blocker, calcium channel blocker, antiplatelet, steroids, statin, isoflurane), a negative relationship was found between preoperative use of ACEIs/ARBs and occurrence of POD (OR = 0.15, 95%CI: 0.03 to 0.80, P = 0.0266).ConclusionPreoperative use of ACEIs/ARBs in patients with PAH reduces the risk of POD. ACEIs/ARBs may be more recommended for patients with PAH in the future.