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Background <p>Postoperative delirium (POD) is a common neurological complication in older patients. Frailty is an independent risk factor for POD, and sarcopenia has been increasingly linked to cognitive decline through the emerging concept of the brain–muscle axis. This study aimed to evaluate the predictive value of preoperative point-of-care ultrasound (POCUS) measurements of the quadriceps and vastus intermedius muscles for POD.</p> Methods <p>In this prospective observational study, 236 patients aged ≥ 65&#xa0;years [median (IQR): 72 (69–76)] scheduled for major non-cardiac surgery were enrolled. The POCUS was used to quantitate preoperative quadriceps femoris muscle thickness (QF-MT). POD was assessed daily until postoperative day 7 using the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM) or the CAM-ICU. Univariate and multivariate logistic regression analyses were performed to identify key factors associated with POD. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive efficacy of ultrasonic parameters.</p> Results <p>POD occurred in 33 patients (14.0%). Multivariate analysis identified advanced age (OR: 1.182, 95% CI 1.054–1.328, <i>p</i> = 0.005), preoperative frailty (OR: 3.226, 95% CI 1.120–9.287, <i>p</i> = 0.030), and lower QF-MT (OR: 0.006, 95% CI 0.000–0.073, <i>p</i> &lt; 0.010) as independent predictors. ROC analysis showed that QF-MT alone had an AUC of 0.843 (95% CI 0.773–0.913) for predicting POD, which increased to 0.916 (95% CI 0.868–0.964) when combined with age.</p> Conclusion <p>Preoperative POCUS assessment of QF-MT is a promising tool for predicting POD in older adult patients. Its integration into preoperative risk stratification could facilitate the early identification of high-risk patients.</p> Trial registration number <p>ChiCTR2500106607.</p>

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Point-of-care quadriceps muscle ultrasound as a predictor of postoperative delirium in older adults: a prospective cohort study

  • 期刊论文

  • 发表日期：

    2026年5月13日

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  • Zihuan Xu,
  • Gaolin Qiu,
  • Tingting Peng,
  • Qiuyu Liu,
  • Qiuling Du,
  • Wenxin Zhang,
  • Yahui Xu,
  • Xuesheng Liu,
  • Panpan Fang

摘要

Background

Postoperative delirium (POD) is a common neurological complication in older patients. Frailty is an independent risk factor for POD, and sarcopenia has been increasingly linked to cognitive decline through the emerging concept of the brain–muscle axis. This study aimed to evaluate the predictive value of preoperative point-of-care ultrasound (POCUS) measurements of the quadriceps and vastus intermedius muscles for POD.

Methods

In this prospective observational study, 236 patients aged ≥ 65 years [median (IQR): 72 (69–76)] scheduled for major non-cardiac surgery were enrolled. The POCUS was used to quantitate preoperative quadriceps femoris muscle thickness (QF-MT). POD was assessed daily until postoperative day 7 using the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM) or the CAM-ICU. Univariate and multivariate logistic regression analyses were performed to identify key factors associated with POD. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive efficacy of ultrasonic parameters.

Results

POD occurred in 33 patients (14.0%). Multivariate analysis identified advanced age (OR: 1.182, 95% CI 1.054–1.328, p = 0.005), preoperative frailty (OR: 3.226, 95% CI 1.120–9.287, p = 0.030), and lower QF-MT (OR: 0.006, 95% CI 0.000–0.073, p < 0.010) as independent predictors. ROC analysis showed that QF-MT alone had an AUC of 0.843 (95% CI 0.773–0.913) for predicting POD, which increased to 0.916 (95% CI 0.868–0.964) when combined with age.

Conclusion

Preoperative POCUS assessment of QF-MT is a promising tool for predicting POD in older adult patients. Its integration into preoperative risk stratification could facilitate the early identification of high-risk patients.

Trial registration number

ChiCTR2500106607.