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The underlying pathophysiology is not fully understood, but is suggested to be multifactorial, including hypoperfusion and hypoxia; however, the role of deviating vital signs prior to postoperative delirium (POD) remains unclear. This study aimed to examine the association between severe physiological deviations detected by continuous wireless monitoring and the occurrence of POD within the first three postoperative days after major abdominal cancer surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective substudy, the primary outcome delirium was assessed daily with the validated 3D\u2010CAM questionnaire during the first three postoperative days following major abdominal cancer surgery, and patients were classified into three groups: POD, neurocognitive decline (NCD), and no cognitive impairment (controls). Vital signs (blood pressure, respiratory rate, heart rate, and peripheral oxygen saturation) were continuously monitored for up to 96\u2009h postoperatively. The primary exposure was the cumulative duration of severely deviating vital signs 24\u2009h before POD diagnosis. Secondary exposures included the frequency of sustained severe vital sign deviation episodes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 225 patients with complete 3D\u2010CAM data, 22 (9.8%) developed POD, 73 (32.4%) had NCD, and 130 (57.8%) had no cognitive impairment (controls). The median cumulative duration of vital sign deviations 24\u2009h prior to POD was not significantly different between POD patients and controls (204\u2009min vs. 325\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.63). Episodes of sustained tachycardia, bradycardia, and bradypnea in the 24\u2009h prior to POD diagnosis were more frequent in POD patients compared to controls, all\n                      <jats:italic>p\u2009&lt;<\/jats:italic>\n                      \u20090.001. In the 24\u2009h after POD diagnosis, patients with POD also exhibited more frequent episodes of sustained tachypnea, desaturation, tachycardia, and hypertension than controls (all\n                      <jats:italic>p\u2009\u2264<\/jats:italic>\n                      \u20090.005). In NCD patients, deviations were intermediate: bradypnea and bradycardia were more frequent before, and tachycardia, hypotension, hypertension, and desaturation more frequent after the NCD assessment, compared with controls.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Although the cumulative duration of severe vital sign deviations did not differ between\n                      <jats:styled-content style=\"fixed-case\">POD<\/jats:styled-content>\n                      patients and controls, episodes of sustained severe vital sign deviations were significantly more frequent in\n                      <jats:styled-content style=\"fixed-case\">POD<\/jats:styled-content>\n                      patients before and after\n                      <jats:styled-content style=\"fixed-case\">POD<\/jats:styled-content>\n                      diagnosis, suggesting a potential for earlier identification of patients at risk. Whether acting on these signals alters the incidence of delirium was not tested and requires a prospective study.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Editorial Comment<\/jats:title>\n                    <jats:p>In this secondary analysis of a prospectively assessed high risk surgical cohort, postoperative vital sign deviations acquired from wireless technology were analysed for possible relations to postoperative delirium development. The findings show that vital sign deviation was observed often before or after delirium development, though it is not yet clear which category or measurement of vital sign deviation would be most likely to be associated with delirium.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>NCT03491137<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.70347","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T23:26:56Z","timestamp":1791329216000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative Delirium and the Association to Continuously Monitored Severe Deviations of Vital Signs at the General Ward After Major Abdominal Surgery"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4239-9892","authenticated-orcid":false,"given":"Hussein Nasser","family":"Awada","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet  Copenhagen Denmark"},{"name":"Department of Cardiothoracic Surgery Heart Centre, Copenhagen University Hospital, Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8646-5666","authenticated-orcid":false,"given":"Camilla","family":"Haahr\u2010Raunkj\u00e6r","sequence":"additional","affiliation":[{"name":"Department of Anaesthaesia and Intensive Care Copenhagen University Hospital, Bispebjerg and Frederiksberg  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2062-9570","authenticated-orcid":false,"given":"Jesper","family":"M\u00f8lgaard","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6297-2871","authenticated-orcid":false,"given":"S\u00f8ren M\u00f8ller","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Biomedical Signal Processing &amp; AI Research Group, Digital Health Section, Department of Health Technology Technical University of Denmark  Kgs. Lyngby Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4885-4609","authenticated-orcid":false,"given":"Christian Sylvest","family":"Meyhoff","sequence":"additional","affiliation":[{"name":"Department of Anaesthaesia and Intensive Care Copenhagen University Hospital, Bispebjerg and Frederiksberg  Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7131-2461","authenticated-orcid":false,"given":"Eske Kvanner","family":"Aasvang","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet  Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen 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