Study: Non-salicylate NSAIDs reduce risk of postoperative delirium

Editor's Note

A study presented at the 2024 American Society of Anesthesiologists annual meeting suggests that non-salicylate NSAIDs may significantly reduce the risk of postoperative delirium, a serious complication affecting up to 15% of surgical patients, Anesthesiology News reported October 20. Delirium is especially prevalent in older adults and those with conditions like hip fractures, with contributing factors including pain, age, stress, anxiety, and insomnia.

Researchers reviewed data from surgical patients who received anesthesia between 2014 and 2023, comparing rates of delirium based on medication administered—acetaminophen, salicylate NSAIDs (eg, aspirin), or non-salicylate NSAIDs (eg, ibuprofen, ketorolac, celecoxib). The medications were given orally or intravenously on the day of surgery.

For patients aged 18 to 64, non-salicylate NSAIDs reportedly lowered delirium risk by 22% compared to acetaminophen and by 70% compared to salicylate NSAIDs. For patients aged 65 and older, the same figures were 33% and 45%, respectively.

The results suggest non-salicylate NSAIDs could be more effective than acetaminophen in reducing delirium, possibly due to reducing opioid use post-surgery. However, Steven M. Frank, MD, from Johns Hopkins School of Medicine, cautioned that while NSAIDs may enhance surgical safety, their side effects—including nausea, kidney impairment, and bleeding risks—must be considered, especially in younger patients with lower delirium risk.