{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T06:38:41Z","timestamp":1765262321021,"version":"3.46.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We enrolled frail elderly patients (defined as Clinical Frailty Scale \u2265 5) scheduled for elective non-cardiac surgery. Patients received either anesthesia involving remimazolam (R group,\n                      <jats:italic>n<\/jats:italic>\n                      = 301) or conventional general anesthesia without remimazolam (C group,\n                      <jats:italic>n<\/jats:italic>\n                      = 305), based on the attending anesthesiologist\u2019s clinical decision. The primary outcome was the incidence of POD within the first three postoperative days, assessed by trained, blinded researchers using the 3-min Confusion Assessment Method (3D-CAM). Secondary outcomes included postoperative recovery quality (agitation, sleep, pain) and intraoperative safety parameters.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between June 2024 and June 2025, a total of 606 patients were enrolled and analyzed (R group:\n                      <jats:italic>n<\/jats:italic>\n                      = 301; C group:\n                      <jats:italic>n<\/jats:italic>\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\u20130.99;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.038). The remimazolam group also experienced less emergence agitation and, by postoperative day 3, reported significantly better sleep quality and lower pain scores (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 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\u20130.98,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.041), while advanced age and longer anesthesia duration were independent risk factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1684779","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T06:29:14Z","timestamp":1765261754000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The effect of remimazolam versus conventional anesthesia on postoperative delirium in frail patients: a prospective, controlled cohort study"],"prefix":"10.3389","volume":"12","author":[{"given":"Yanjie","family":"Yang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhangnan","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiangli","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lining","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuxian","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1097\/01.SLA.0000081085.98792.3d","article-title":"The aging population and its impact on the surgery workforce.","volume":"238","author":"Etzioni","year":"2003","journal-title":"Ann Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"M146","DOI":"10.1093\/gerona\/56.3.m146","article-title":"Frailty in older adults: evidence for a phenotype.","volume":"56","author":"Fried","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci."},{"key":"B3","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"global clinical measure of fitness and frailty in elderly people.","volume":"173","author":"Rockwood","year":"2005","journal-title":"Cmaj."},{"key":"B4","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1186\/s12877-016-0329-8","article-title":"Frailty and post-operative outcomes in older surgical patients: a systematic review.","volume":"16","author":"Lin","year":"2016","journal-title":"BMC Geriatr."},{"key":"B5","doi-asserted-by":"publisher","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying confusion: the confusion assessment method. 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