{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T12:01:26Z","timestamp":1778500886727,"version":"3.51.4"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T00:00:00Z","timestamp":1655251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007128","name":"Natural Science Foundation of Shaanxi Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007128","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007128","name":"Natural Science Foundation of Shaanxi Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007128","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Postoperative delirium is common in elderly patients following major surgery. This study aimed to assess the effect of transcutaneous electrical acupoint stimulation combined with auricular acupressure on the incidence of postoperative delirium among older patients undergoing major abdominal surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this single-center, randomized controlled clinical trial, 210 patients aged 65 years or older undergoing major abdominal surgery were randomized to receive either intervention treatment (transcutaneous electrical acupoint stimulation started at 30 min before anesthesia until the end of the surgery, followed by intermittent auricular acupressure in the first three postoperative days; <jats:italic>n<\/jats:italic> = 105) or standard care (<jats:italic>n<\/jats:italic> = 105). The primary outcome was the incidence of delirium at the first seven postoperative days or until hospitalization depended on which came first. Secondary outcomes included delirium severity, opioid consumption, postoperative pain score, sleep quality, length of postoperative hospital stay, and postoperative 30-day complications. Enrollment was from April 2019 to March 2020, with follow-up ending in April 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All of the 210 randomized patients [median age, 69.5 years, 142 (67.6%) male] completed the trial. The incidence of postoperative delirium was significantly reduced in patients received intervention treatment (19\/105 (18.1%) vs. 8\/105 (7.6%), difference, \u201310.5% [95% CI, \u20131.5% to \u201319.4%]; hazard ratio, 0.41 [95% CI, 0.18 to 0.95]; P= 0.023). Patients in the control group had a higher postoperative Memorial Delirium Assessment Scale (4 <jats:italic>vs.<\/jats:italic> 3; difference, \u20131; 95% CI, \u20131 to 0; <jats:italic>P<\/jats:italic> = 0.014) and a greater increase in Pittsburgh Sleep Quality Index score from baseline to postoperative day three (2.5 <jats:italic>vs.<\/jats:italic> 2.0; difference, \u20131; 95% CI, \u20132 to \u20131; <jats:italic>P<\/jats:italic> &amp;lt; 0.001) than patients in the intervention group. No significant difference was observed as of other secondary outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In elderly patients undergoing major abdominal surgery, transcutaneous electrical acupoint stimulation combined with auricular acupressure reduced the incidence of postoperative in-hospital delirium compared with standard care. A multicenter, randomized clinical trial with a larger sample size is necessary to verify these findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration<\/jats:title><jats:p>[<jats:ext-link>https:\/\/clinicaltrials.gov<\/jats:ext-link>], identifier [NCT03726073].<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.855296","type":"journal-article","created":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T07:37:26Z","timestamp":1655278646000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["Transcutaneous Electrical Acupoint Stimulation Combined With Auricular Acupressure Reduces Postoperative Delirium Among Elderly Patients Following Major Abdominal Surgery: A Randomized Clinical Trial"],"prefix":"10.3389","volume":"9","author":[{"given":"Qianqian","family":"Fan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chong","family":"Lei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yonghui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nannan","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lini","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingwen","family":"Fu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hailong","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhihong","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lize","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.bja.2020.06.063","article-title":"Postoperative delirium: perioperative assessment, risk reduction, and management.","volume":"125","author":"Jin","year":"2020","journal-title":"Br J Anaesth."},{"key":"B2","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1097\/aln.0000000000003016","article-title":"Intraoperative oxidative damage and delirium after cardiac surgery.","volume":"132","author":"Lopez","year":"2020","journal-title":"Anesthesiology."},{"key":"B3","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1016\/s0140-6736(13)60688-1","article-title":"Delirium in elderly people.","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1016\/s0140-6736(16)30580-3","article-title":"Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial.","volume":"388","author":"Su","year":"2016","journal-title":"Lancet."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1001\/jamasurg.2015.2606","article-title":"Effect of delirium and other major complications on outcomes after elective surgery in older adults.","volume":"150","author":"Gleason","year":"2015","journal-title":"JAMA Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1001\/jamasurg.2017.1083","article-title":"Effect of a modified hospital elder life program on delirium and length of hospital stay in patients undergoing abdominal surgery: a cluster randomized clinical trial.","volume":"152","author":"Chen","year":"2017","journal-title":"JAMA Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e21","DOI":"10.1002\/bjs.10062","article-title":"Systematic review and meta-analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery.","volume":"103","author":"Scholz","year":"2016","journal-title":"Br J Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1097\/eja.0000000000000594","article-title":"European society of anaesthesiology evidence-based and consensus-based guideline on postoperative delirium.","volume":"34","author":"Aldecoa","year":"2017","journal-title":"Eur J Anaesthesiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1093\/bja\/aev227","article-title":"Perioperative acupuncture modulation: more than anaesthesia.","volume":"115","author":"Lu","year":"2015","journal-title":"Br J Anaesth."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/9641904","article-title":"Application of acupuncture to attenuate immune responses and oxidative stress in postoperative cognitive dysfunction: what do we know so far?","volume":"2020","author":"Ho","year":"2020","journal-title":"Oxid Med Cell Longev."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1093\/jnci\/djz050","article-title":"Acupuncture versus cognitive behavioral therapy for insomnia in cancer survivors: a randomized clinical trial.","volume":"111","author":"Garland","year":"2019","journal-title":"J Natl Cancer Inst."},{"key":"B12","doi-asserted-by":"publisher","first-page":"2127","DOI":"10.2147\/cia.s183698","article-title":"Transcutaneous electrical acupoint stimulation for prevention of postoperative delirium in geriatric patients with silent lacunar infarction: a preliminary study.","volume":"13","author":"Gao","year":"2018","journal-title":"Clin Interv Aging."},{"key":"B13","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1136\/aim.2010.003251","article-title":"Randomised, controlled study of preoperative eletroacupuncture for postoperative pain control after cardiac surgery.","volume":"29","author":"Coura","year":"2011","journal-title":"Acupunct Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"2703","DOI":"10.1001\/jama.286.21.2703","article-title":"Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU).","volume":"286","author":"Ely","year":"2001","journal-title":"JAMA."},{"key":"B15","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1097\/SLA.0b013e31818e4776","article-title":"Postoperative delirium in the elderly: risk factors and outcomes.","volume":"249","author":"Robinson","year":"2009","journal-title":"Ann Surg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.ijnurstu.2015.10.006","article-title":"Auricular acupressure relieves anxiety and fatigue, and reduces cortisol levels in post-caesarean section women: a single-blind, randomised controlled study.","volume":"53","author":"Kuo","year":"2016","journal-title":"Int J Nurs Stud."},{"key":"B17","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1093\/ecam\/nep172","article-title":"Auricular acupunctures are effective for the prevention of postoperative agitation in old patients.","volume":"7","author":"Arai","year":"2010","journal-title":"Evid Based Complement Altern Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1016\/j.ijnurstu.2013.06.007","article-title":"Integrative acupoint stimulation to alleviate postoperative pain and morphine-related side effects: a sham-controlled study.","volume":"51","author":"Chung","year":"2014","journal-title":"Int J Nurs Stud."},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1177\/15347354211019103","article-title":"Electroacupuncture plus auricular acupressure for chemotherapy-associated insomnia in breast cancer patients: a pilot randomized controlled trial.","volume":"20","author":"Zhang","year":"2021","journal-title":"Integr Cancer Ther."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.1505","article-title":"Intraoperative infusion of dexmedetomidine for prevention of postoperative delirium and cognitive dysfunction in elderly patients undergoing major elective noncardiac surgery: a randomized clinical trial.","volume":"152","author":"Deiner","year":"2017","journal-title":"JAMA Surg."},{"key":"B21","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.brainresbull.2015.10.011","article-title":"Electro-acupuncture at LI11 and ST36 acupoints exerts neuroprotective effects via reactive astrocyte proliferation after ischemia and reperfusion injury in rats.","volume":"120","author":"Tao","year":"2016","journal-title":"Brain Res Bull."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1093\/bja\/aeu001","article-title":"Transcutaneous electric acupoint stimulation reduces intra-operative remifentanil consumption and alleviates postoperative side-effects in patients undergoing sinusotomy: a prospective, randomized, placebo-controlled trial.","volume":"112","author":"Wang","year":"2014","journal-title":"Br J Anaesth."},{"key":"B23","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1142\/s0192415x0200051x","article-title":"Effectiveness of auricular therapy on sleep promotion in the elderly.","volume":"30","author":"Suen","year":"2002","journal-title":"Am J Chin Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1089\/acm.2006.6400","article-title":"Auricular acupuncture treatment for insomnia: a systematic review.","volume":"13","author":"Chen","year":"2007","journal-title":"J Altern Complement Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1111\/j.1532-5415.2005.53120.x","article-title":"A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method.","volume":"53","author":"Inouye","year":"2005","journal-title":"J Am Geriatr Soc."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1164\/rccm.2107138","article-title":"The Richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients.","volume":"166","author":"Sessler","year":"2002","journal-title":"Am J Respir Crit Care Med."},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2021.784356","article-title":"The locus coeruleus noradrenaline system in delirium.","volume":"13","author":"Hansen","year":"2021","journal-title":"Front Aging Neurosci."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2020.568051","article-title":"International consensus based review and recommendations for minimum reporting standards in research on transcutaneous vagus nerve stimulation (version 2020).","volume":"14","author":"Farmer","year":"2020","journal-title":"Front Hum Neurosci."},{"key":"B29","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1111\/joa.13122","article-title":"The anatomical basis for transcutaneous auricular vagus nerve stimulation.","volume":"236","author":"Butt","year":"2020","journal-title":"J Anat."},{"key":"B30","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1097\/aln.0000000000002729","article-title":"Postoperative delirium and postoperative cognitive dysfunction: overlap and divergence.","volume":"131","author":"Daiello","year":"2019","journal-title":"Anesthesiol."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1186\/s12906-017-1792-2","article-title":"What intrinsic factors influence responsiveness to acupuncture in pain: a review of pre-clinical studies that used responder analysis.","volume":"17","author":"Kim","year":"2017","journal-title":"BMC Compl Altern Med."},{"key":"B32","first-page":"274","article-title":"Epidemiology of insomnia: a longitudinal study in a UK population.","volume":"30","author":"Morphy","year":"2007","journal-title":"Sleep."},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2019.08.001","article-title":"Promoting sleep and circadian health may prevent postoperative delirium: a systematic review and meta-analysis of randomized clinical trials.","volume":"48","author":"Lu","year":"2019","journal-title":"Sleep Med Rev."},{"key":"B34","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1007\/s00540-015-2057-1","article-title":"Effects of transcutaneous electrical acupoint stimulation at different frequencies on perioperative anesthetic dosage, recovery, complications, and prognosis in video-assisted thoracic surgical lobectomy: a randomized, double-blinded, placebo-controlled trial.","volume":"31","author":"Huang","year":"2017","journal-title":"J Anesth."},{"key":"B35","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1177\/0885066617708558","article-title":"Meta-analysis of electroacupuncture in cardiac anesthesia and intensive care.","volume":"34","author":"Asmussen","year":"2019","journal-title":"J Intens Care Med."},{"key":"B36","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1002\/gps.5031","article-title":"An integrative review of acupressure interventions for older people: a focus on sleep quality, depression, anxiety, and agitation.","volume":"34","author":"Hmwe","year":"2019","journal-title":"Int J Geriatr Psychiatry."},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/495684","article-title":"The history, mechanism, and clinical application of auricular therapy in traditional chinese medicine.","volume":"2015","author":"Hou","year":"2015","journal-title":"Evid Based Complement Altern Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1111\/jgs.16987","article-title":"Adaptation and validation of a chart-based delirium detection tool for the ICU (CHART-DEL-ICU).","volume":"69","author":"Krewulak","year":"2021","journal-title":"J Am Geriatr Soc."},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-12-63","article-title":"The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (oslo orthogeriatric trial).","volume":"12","author":"Watne","year":"2014","journal-title":"BMC Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1615","DOI":"10.1007\/s00415-019-09506-7","article-title":"Cognitive assessment tools for mild cognitive impairment screening.","volume":"268","author":"Zhuang","year":"2021","journal-title":"J Neurol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/j.bja.2017.10.024","article-title":"Intraoperative electroencephalogram suppression at lower volatile anaesthetic concentrations predicts postoperative delirium occurring in the intensive care unit.","volume":"121","author":"Fritz","year":"2018","journal-title":"Br J Anaesth."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.855296\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T07:37:32Z","timestamp":1655278652000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.855296\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,15]]},"references-count":41,"alternative-id":["10.3389\/fmed.2022.855296"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.855296","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,15]]},"article-number":"855296"}}