{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:12:50Z","timestamp":1789398770696,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objective: Postoperative pain and delirium are frequent and clinically relevant complications in patients undergoing major cardiac or neurosurgical procedures. The interaction between these conditions remains insufficiently characterized, particularly across heterogeneous surgical populations. This study aimed to investigate the relationship between postoperative pain intensity and delirium severity within the first 48 h after surgery in cardiac and neurosurgical patients. Methods: This retrospective observational analysis included 408 individuals\u2014202 following cardiac surgery and 206 after neurosurgical procedures. Pain intensity was measured using the Numerical Rating Scale (NRS), while delirium presence and severity were assessed using the CAM-ICU and CAM-ICU-7 instruments. Associations between NRS scores, delirium severity, demographic characteristics, and ICU length of stay were examined. Results: Cardiac surgery patients experienced higher pain levels on postoperative day 1 compared with neurosurgical patients; this difference was not observed on day 2. In the cardiac cohort, higher NRS scores were positively associated with greater delirium severity on both postoperative days. No such association was detected in the neurosurgical group. Pain scores also differed across procedure types within each specialty, and several demographic variables (age, sex, ICU stay duration) were linked with variations in pain intensity. On postoperative day 1, pain intensity showed a moderate association with delirium severity (Spearman \u03c1 = 0.23; 95% CI 0.14\u20130.32). Patients who developed delirium had higher pain scores (r = 0.25). In ordinal logistic regression, greater pain on postoperative day 1 independently predicted higher delirium severity (OR 2.24; 95% CI 1.70\u20132.94). Conclusions: Significant associations between postoperative pain intensity and delirium severity were identified in cardiac surgery patients, whereas no similar pattern emerged among neurosurgical patients. Given the retrospective design and incomplete data on perioperative pharmacotherapy, the findings should be interpreted descriptively and do not support causal conclusions. These results underscore the importance of systematic monitoring of pain and cognitive function in high-risk postoperative populations and highlight the need for prospective studies to elucidate the complex interplay between pain, perioperative factors, and postoperative delirium.<\/jats:p>","DOI":"10.3390\/jcm14248840","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:57:24Z","timestamp":1765879044000},"page":"8840","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association Between Postoperative Pain Intensity and Delirium in Cardiac and Neurosurgical Patients: A Retrospective Pilot Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3094-2385","authenticated-orcid":false,"given":"Mateusz","family":"Szczupak","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4860-5951","authenticated-orcid":false,"given":"Jacek","family":"Kobak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Faculty of Medicine, Medical University of Gda\u0144sk, Mariana Smoluchowskiego 17 Street, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8968-0978","authenticated-orcid":false,"given":"Jakub","family":"Wi\u015bniewski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanta","family":"Wierzchowska","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Copernicus Hospital in Gda\u0144sk, 80-803 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3002-3153","authenticated-orcid":false,"given":"Sabina","family":"Krupa-Nurcek","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, Collegium Medicum, University of Rzesz\u00f3w, 35-959 Rzesz\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.1111\/jgs.14434","article-title":"Delirium After Spine Surgery in Older Adults: Incidence, Risk Factors, and Outcomes","volume":"64","author":"Brown","year":"2016","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Sato, T., Hatakeyama, S., Okamoto, T., Yamamoto, H., Hosogoe, S., Tobisawa, Y., Yoneyama, T., Hashiba, E., Yoneyama, T., and Hashimoto, Y. (2016). Slow Gait Speed and Rapid Renal Function Decline Are Risk Factors for Postoperative Delirium after Urological Surgery. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153961"},{"key":"ref_3","doi-asserted-by":"crossref","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":"ref_4","first-page":"188","article-title":"Delirium syndrome in the postoperative period","volume":"17","author":"Cierzniakowska","year":"2023","journal-title":"Piel\u0119gniarstwo Chir. I Angiol.\/Surg. Vasc. Nurs."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Winter, A., Steurer, M.P., and Dullenkopf, A. (2015). Postoperative delirium assessed by post anesthesia care unit staff utilizing the Nursing Delirium Screening Scale: A prospective observational study of 1000 patients in a single Swiss institution. BMC Anesthesiol., 15.","DOI":"10.1186\/s12871-015-0168-8"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"341.e15","DOI":"10.1016\/j.urolonc.2018.04.012","article-title":"A contemporary population-based analysis of the incidence, cost, and outcomes of postoperative delirium following major urologic cancer surgeries","volume":"36","author":"Ha","year":"2018","journal-title":"Urol. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/EJA.0000000000000107","article-title":"Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient: A prospective observational study","volume":"32","author":"Drews","year":"2015","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_8","doi-asserted-by":"crossref","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":"Anesthesiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/j.jalz.2016.03.005","article-title":"The short-term and long-term relationship between delirium and cognitive trajectory in older surgical patients","volume":"12","author":"Inouye","year":"2016","journal-title":"Alzheimers Dement."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1002\/bjs.6843","article-title":"Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery","volume":"97","author":"Ansaloni","year":"2010","journal-title":"Br. J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1093\/ejcts\/ezt572","article-title":"Outcomes of patients with antiphospholipid syndrome after pulmonary endarterectomy","volume":"46","author":"Camous","year":"2014","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chaiwat, O., Chanidnuan, M., Pancharoen, W., Vijitmala, K., Danpornprasert, P., Toadithep, P., and Thanakiattiwibun, C. (2019). Postoperative delirium in critically ill surgical patients: Incidence, risk factors, and predictive scores. BMC Anesthesiol., 19, Erratum in BMC Anesthesiol.\u00a02019, 19, 58. https:\/\/doi.org\/10.1186\/s12871-019-0732-8. PMID: 30894129; PMCID: PMC6425578.","DOI":"10.1186\/s12871-019-0694-x"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s41999-019-00281-2","article-title":"Pain and delirium: Mechanisms, assessment, and management","volume":"11","author":"Sampson","year":"2020","journal-title":"Eur. Geriatr. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1038\/s41572-020-00223-4","article-title":"Delirium","volume":"6","author":"Wilson","year":"2020","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s10143-021-01619-w","article-title":"Delirium in neurosurgery: A systematic review and meta-analysis","volume":"45","author":"Kappen","year":"2022","journal-title":"Neurosurg. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e2249950","DOI":"10.1001\/jamanetworkopen.2022.49950","article-title":"Predisposing and Precipitating Factors Associated With Delirium: A Systematic Review","volume":"6","author":"Ormseth","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"afae073","DOI":"10.1093\/ageing\/afae073","article-title":"Understanding the association between pain and delirium in older hospital inpatients: Systematic review and meta-analysis","volume":"53","author":"White","year":"2024","journal-title":"Age Ageing"},{"key":"ref_19","first-page":"486","article-title":"Cardiac surgery: A century of progress","volume":"38","author":"Weisse","year":"2011","journal-title":"Tex. Heart Inst. J."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Gilard, V., Derrey, S., Marret, S., Bekri, S., and Tebani, A. (2021). Precision Neurosurgery: A Path Forward. J. Pers. Med., 11.","DOI":"10.3390\/jpm11101019"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1097\/CCM.0000000000002368","article-title":"The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU","volume":"45","author":"Khan","year":"2017","journal-title":"Crit. Care Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1186\/s13054-016-1513-0","article-title":"Mediation analysis to unravel mechanisms underlying association between platelet transfusion and postoperative delirium","volume":"20","author":"Zhang","year":"2016","journal-title":"Crit. Care"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Zhang, Z. (2023). Editorial: Postoperative care: From pain management to delirium. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1179358"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1002\/ana.25889","article-title":"Association of Plasma Neurofilament Light with Postoperative Delirium","volume":"88","author":"Fong","year":"2020","journal-title":"Ann. Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.bpa.2006.12.007","article-title":"Postoperative pain management and outcome after surgery","volume":"21","author":"Bonnet","year":"2007","journal-title":"Best. Pract. Res. Clin. Anaesthesiol."},{"key":"ref_26","first-page":"9657109","article-title":"Factors Associated with Postoperative Pain among Patients after Cardiac Surgery in the Tertiary Care Teaching Hospital of Karachi, Pakistan","volume":"2019","author":"Micah","year":"2019","journal-title":"Pain. Res. Treat."},{"key":"ref_27","first-page":"398","article-title":"Delirium and pain in patients in the immediate postoperative period of cardiac surgery: Prevalence and associated risk factors\/Delirium e dor em pacientes no p\u00f3s-operat\u00f3rio imediato de cirurgia card\u00edaca: Preval\u00eancia e fatores de risco associados","volume":"6","author":"Baltazar","year":"2023","journal-title":"BrJP"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1001\/jama.2012.6857","article-title":"Postoperative delirium: A 76-year-old woman with delirium following surgery","volume":"308","author":"Marcantonio","year":"2012","journal-title":"JAMA"},{"key":"ref_29","first-page":"1066","article-title":"Postoperative delirium: Risk factors, diagnosis and perioperative care","volume":"79","author":"Bilotta","year":"2013","journal-title":"Minerva Anestesiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.1053\/j.jvca.2020.02.004","article-title":"Predisposing and Precipitating Factors Associated With Postoperative Delirium in Patients Undergoing Cardiac Surgery at a Veterans Affairs Medical Center: A Pilot Retrospective Analysis","volume":"34","author":"Russell","year":"2020","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1186\/s13054-015-1060-0","article-title":"Risk factors for delirium after on-pump cardiac surgery: A systematic review","volume":"19","author":"Gosselt","year":"2015","journal-title":"Crit. Care"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8840\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T12:23:23Z","timestamp":1765974203000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8840"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,13]]},"references-count":31,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248840"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248840","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,13]]}}}