{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:21:50Z","timestamp":1792603310867,"version":"4.5.0"},"reference-count":44,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,27]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Inadequate emergence is a common postoperative complication in elderly patients following major abdominal surgery. This study was designed to determine its incidence, identify associated risk factors and characterise its clinical subtypes within this high-risk cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>This prospective single-centre cohort study was conducted at a comprehensive specialised tertiary care hospital in Northwest Ethiopia. Consecutive patients aged 65 years and older scheduled for elective major abdominal surgery under general anaesthesia were enrolled.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measure<\/jats:title>\n                    <jats:p>The primary outcome was the proportion of patients experiencing inadequate emergence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 388 patients were analysed. Inadequate emergence occurred in 21.9% of participants (95%\u2009CI 14.3% to 31.6%), with hypoactive emergence observed in 10.7% and emergence delirium in 11.2%. Multivariable logistic regression identified several independent predictors, including advanced age (adjusted OR (AOR)=1.9; 95%\u2009CI 1.5 to 8.2), preoperative anxiety (AOR=2.7; 95%\u2009CI 1.2 to 7.2), prolonged preoperative fasting (AOR=2.1; 95%\u2009CI 1.8 to 9.1), non-ketofol-based induction (AOR=3.4; 95%\u2009CI 1.6 to 6.3), absence of abdominal field block (AOR=4.2; 95%\u2009CI 4.0 to 9.6), substantial intraoperative blood loss (&gt;1000\u2009mL; AOR=1.9; 95%\u2009CI 1.2 to 7.6), postoperative nausea and vomiting requiring antiemetics (AOR=2.2; 95%\u2009CI 2.1 to 7.1) and presence of an indwelling urinary catheter (AOR=2.4; 95%\u2009CI 1.8 to 7.9).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Inadequate emergence occurred in approximately one in five elderly patients undergoing elective major abdominal surgery. Independent predictors included advanced age, major intraoperative blood loss, postoperative nausea\/vomiting requiring antiemetics, non-ketofol-based induction, preoperative anxiety, absence of abdominal field block, presence of an indwelling urinary catheter and prolonged preoperative fasting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110013","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T17:05:35Z","timestamp":1777050335000},"page":"e110013","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Incidence and associated factors of inadequate emergence in elderly patients undergoing elective major abdominal surgery: a prospective cohort study in Northwest Ethiopia"],"prefix":"10.1136","volume":"16","author":[{"given":"Samuel Debas","family":"Bayable","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Bahir Dar University College of 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