ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
This article is part of the Research TopicChallenges and Innovations in Healthcare Management and Long-Term Care for an Aging SocietyView all 35 articles
The Effect of Remimazolam versus Conventional Anesthesia on Postoperative Delirium in Frail Patients: A Prospective, Controlled Cohort Study
Provisionally accepted
- Second Hospital of Hebei Medical University, Shijiazhuang, China
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Background: Frail elderly patients are at high risk for postoperative delirium (POD), a serious complication associated with poor outcomes. The choice of anesthetic agent may represent a modifiable risk factor. This study aimed to compare the effect of anesthesia involving remimazolam versus conventional general anesthesia without remimazolam on the incidence of POD in this vulnerable population. Methods: We enrolled frail elderly patients (defined as Clinical Frailty Scale ≥ 5) scheduled for elective non-cardiac surgery. Patients received either anesthesia involving remimazolam (R group, n=301) or conventional general anesthesia without remimazolam (C group, n=305), based on the attending anesthesiologist's clinical decision. The primary outcome was the incidence of POD within the first three postoperative days, assessed by trained, blinded researchers using the 3-Minute Confusion Assessment Method (3D-CAM). Secondary outcomes included postoperative recovery quality (agitation, sleep, pain) and intraoperative safety parameters. Results: Between June 2024 and June 2025, a total of 606 patients were enrolled and analyzed (R group: n=301; C group: n=305). The overall incidence of POD was significantly lower in the R group (119/301, 39.5%) compared to the C group (143/305, 46.9%) (Relative Risk 0.84; 95% CI 0.71-0.99; P=0.038). The remimazolam group also experienced less emergence agitation and, by postoperative day 3, reported significantly better sleep quality and lower pain scores (P<0.01). A multivariate logistic regression identified the use of remimazolam as an independent protective factor against POD (Adjusted Odds Ratio 0.68, 95% CI 0.47-0.98, P=0.041), while advanced age and longer anesthesia duration were independent risk factors. Conclusion: In this cohort of frail elderly patients, the use of remimazolam for general anesthesia was associated with a lower incidence of postoperative delirium compared to conventional anesthesia. This choice represents a promising, modifiable strategy for improving neurological outcomes in this high-risk group.
Keywords: Remimazolam, Postoperative delirium (POD), Frail elderly patients, general anesthesia, prospective cohort study
Received: 18 Aug 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Yang, Sun, Wu, Huang and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Shuxian Ma, 28402549@hebmu.edu.cn
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