{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:04:32Z","timestamp":1789452272408,"version":"build-2803163510"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"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>Optic nerve sheath diameter (ONSD) is an indirect, technique-dependent marker of intracranial pressure; its association with delirium after Bentall surgery remains uncertain. Therefore, we assessed serial perioperative ONSD and its relationship with delirium.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective single-centre study included 53 adults undergoing elective Bentall surgery. Delirium analyses included 51 participants whose status was assessable with the Confusion Assessment Method for the Intensive Care Unit; two remained unassessable until death. Bilateral ONSD was measured at 10 perioperative time points. Mixed-effects models evaluated serial ONSD, time-point comparisons were Holm-adjusted, and measures underwent Firth regression and receiver operating characteristic analyses. Sensitivity analyses assigned each indeterminate outcome as either delirium present or absent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Documented delirium occurred in 17 of 51 participants with assessable delirium status (33.3%). Average perioperative ONSD was 0.250\u2005mm higher with delirium (95% confidence interval 0.031\u20130.470;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.025). Across outcome assignments, the difference ranged from 0.237 to 0.248\u2005mm (\n                      <jats:italic>p<\/jats:italic>\n                      -values \u2264 0.029), whereas the time-by-group interaction was sensitive to assignment (\n                      <jats:italic>p<\/jats:italic>\n                      -values ranged from &amp;lt;0.001 to 0.094). No point-specific comparison survived Holm correction (smallest adjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.078), and the post-closure T6 minus preoperative baseline showed no clear group difference (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.147). In an exploratory Firth analysis not adjusted for time-point selection, the odds ratio per 1-mm higher T6 ONSD was 3.75 (95% confidence interval 1.44\u201312.32;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). Areas under the receiver operating characteristic curves were 0.654 for Preop, 0.689 for T0, 0.728 for T6, and 0.626 for change, without evidence of superior T6 discrimination. The five-variable model had an apparent area under the curve of 0.839 and a conditional optimism-corrected value of 0.778; predictor and time-point selection were not repeated during validation. The internally selected 4.90-mm operating point was not an intracranial-hypertension threshold.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher perioperative ONSD was associated with documented delirium, but the temporal interaction was sensitive to unobserved outcomes, and the data did not establish a superior time point or a causal intraoperative change. These findings require external validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT07452367; retrospectively registered 5 March 2026.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1940776","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:35:45Z","timestamp":1789450545000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between perioperative optic nerve sheath diameter and postoperative delirium after Bentall surgery: a prospective observational study"],"prefix":"10.3389","volume":"13","author":[{"given":"An\u0131l","family":"Onur","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Y\u00fcksek \u0130htisas Training and 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