{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T11:04:34Z","timestamp":1793271874465,"version":"4.5.0"},"reference-count":26,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Postoperative delirium (POD) is a transient but significant complication in geriatric patients following hip or femur surgery. POD occurs in 19\u201365% of patients after hip surgeries, with notable risks associated with augmented morbidity, mortality, and prolonged hospitalization. The perioperative administration of benzodiazepines, particularly midazolam, is associated with an increased incidence of POD. Remimazolam, a novel ultra-short-acting benzodiazepine, has potential benefits, such as hemodynamic stability and ease of reversal, but its effect on POD occurrence remains unclear. Materials and Methods: This retrospective study investigated patients who were aged 65 years old and older who underwent hip or femur surgery. Following the application of exclusion criteria, 502 patients were grouped according to whether anesthesia was maintained with remimazolam (R group) or sevoflurane (S group). Data regarding patients\u2019 baseline characteristics, anesthetic details, and postoperative outcomes, including the incidence of POD, were gathered and analyzed. Propensity score matching and logistic regression were conducted to identify factors associated with POD and compare outcomes between the two groups. Results: Among the 502 patients, POD was observed in 161 (32%). The POD incidence was not statistically significantly different between the groups (p = 1.000). A multivariable logistic regression analysis indicated that remimazolam was not a determinant of POD (p = 0.860), whereas being male and polypharmacy were (p = 0.022; p = 0.047). Initial disparities in age and comorbid conditions between the groups were rectified through matching, demonstrating that remimazolam had a similar POD risk to sevoflurane. Conclusions: This study showed that remimazolam did not exacerbate the risk of POD in elderly patients undergoing hip or femur surgery. Remimazolam is a reliable anesthetic option for this vulnerable demographic. Also, this study\u2019s results indicated that polypharmacy and being male are POD risk factors, suggesting that meticulous perioperative medication management may help alleviate the risk of POD.<\/jats:p>","DOI":"10.3390\/medicina61020336","type":"journal-article","created":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T04:48:51Z","timestamp":1739508531000},"page":"336","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Effects of Remimazolam and Inhalational Anesthetics on the Incidence of Postoperative Hyperactive Delirium in Geriatric Patients Undergoing Hip or Femur Surgery Under General Anesthesia: A Retrospective Observational Study"],"prefix":"10.3390","volume":"61","author":[{"given":"Jimin","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangseok","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1958-8380","authenticated-orcid":false,"given":"Byung Hoon","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2399-4768","authenticated-orcid":false,"given":"Yun Hee","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1386-3940","authenticated-orcid":false,"given":"In-Jung","family":"Jun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1007\/s00068-017-0826-2","article-title":"Complications after hip fracture surgery: Are they preventable?","volume":"44","author":"Flikweert","year":"2018","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s13018-020-02127-1","article-title":"Risk factors of postoperative delirium in the knee and hip replacement patients: A systematic review and meta-analysis","volume":"16","author":"Rong","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/0304-3940(84)90514-7","article-title":"Benzodiazepine interactions with GABA receptors","volume":"47","author":"Haefely","year":"1984","journal-title":"Neurosci. Lett."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/j.bja.2017.12.046","article-title":"Postoperative delirium in total knee and hip arthroplasty patients: A study of perioperative modifiable risk factors","volume":"120","author":"Weinstein","year":"2018","journal-title":"Br. J. Anaesth."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.17085\/apm.21115","article-title":"Remimazolam: Pharmacological characteristics and clinical applications in anesthesiology","volume":"17","author":"Kim","year":"2022","journal-title":"Anesth. Pain Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s00540-024-03339-z","article-title":"Effectiveness of remimazolam in preventing postoperative delirium in elderly patients with proximal femoral fractures","volume":"38","author":"Fujimoto","year":"2024","journal-title":"J. Anesth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"143","DOI":"10.2147\/DDDT.S392569","article-title":"Effect of Remimazolam on Postoperative Delirium in Older Adult Patients Undergoing Orthopedic Surgery: A Prospective Randomized Controlled Clinical Trial","volume":"17","author":"Yang","year":"2023","journal-title":"Drug Des. Devel. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1007\/s00540-022-03148-2","article-title":"Effect of remimazolam on the incidence of delirium after transcatheter aortic valve implantation under general anesthesia: A retrospective exploratory study","volume":"37","author":"Kaneko","year":"2023","journal-title":"J. Anesth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s00540-022-03119-7","article-title":"Association between remimazolam and postoperative delirium in older adults undergoing elective cardiovascular surgery: A prospective cohort study","volume":"37","author":"Aoki","year":"2023","journal-title":"J. Anesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/EJA.0000000000001197","article-title":"Modifiable factors associated with postoperative delirium after hip fracture repair: An age-stratified retrospective cohort study","volume":"37","author":"Poeran","year":"2020","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1136\/rapm-2019-100700","article-title":"Risk factors for postoperative delirium in patients undergoing lower extremity joint arthroplasty: A retrospective population-based cohort study","volume":"44","author":"Memtsoudis","year":"2019","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e25399","DOI":"10.1016\/j.heliyon.2024.e25399","article-title":"Benefits of remimazolam as an anesthetic sedative for older patients: A review","volume":"10","author":"Jin","year":"2024","journal-title":"Heliyon"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Liu, X., Lin, S., Zhong, Y., Shen, J., Zhang, X., Luo, S., Huang, L., Zhang, L., Zhou, S., and Tang, J. (2021). Remimazolam Protects Against LPS-Induced Endotoxicity Improving Survival of Endotoxemia Mice. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.739603"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"481","DOI":"10.30773\/pi.2022.0323e","article-title":"Remimazolam Supplemented to General Anesthesia Alleviates Stress and Cognitive Impairment in Elder Patients After Hip Surgery","volume":"20","author":"Sun","year":"2023","journal-title":"Psychiat. Investig."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e00851","DOI":"10.1002\/prp2.851","article-title":"Effect of remimazolam induction on hemodynamics in patients undergoing valve replacement surgery: A randomized, double-blind, controlled trial","volume":"9","author":"Liu","year":"2021","journal-title":"Pharmacol. Res. Perspect."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"So, K.Y., Park, J., and Kim, S.H. (2023). Safety and efficacy of remimazolam for general anesthesia in elderly patients undergoing laparoscopic cholecystectomy: A randomized controlled trial. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1265860"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"850.e11","DOI":"10.1016\/j.jamda.2014.08.012","article-title":"Impact of polypharmacy on occurrence of delirium in elderly emergency patients","volume":"15","author":"Hein","year":"2014","journal-title":"J.Am. Med. Dir. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1002\/pds.2116","article-title":"Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population","volume":"20","author":"Jyrkka","year":"2011","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lertkovit, S., Siriussawakul, A., Suraarunsumrit, P., Lertpipopmetha, W., Manomaiwong, N., Wivatdechakul, W., and Srinonprasert, V. (2022). Polypharmacy in Older Adults Undergoing Major Surgery: Prevalence, Association With Postoperative Cognitive Dysfunction and Potential Associated Anesthetic Agents. Front. Med., 9.","DOI":"10.3389\/fmed.2022.811954"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"American Geriatrics Society Beers Criteria (2023). American Geriatrics Society 2023 updated AGS Beers Criteria(R) for potentially inappropriate medication use in older adults. J. Am. Geriatr. Soc., 71, 2052\u20132081.","DOI":"10.1111\/jgs.18372"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s41999-023-00777-y","article-title":"STOPP\/START criteria for potentially inappropriate prescribing in older people: Version 3","volume":"14","author":"Cherubini","year":"2023","journal-title":"Eur. Geriatr. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Wang, H., Guo, X., Zhu, X., Li, Y., Jia, Y., Zhang, Z., Yuan, S., and Yan, F. (2021). Gender Differences and Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.751421"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.psyneuen.2017.10.007","article-title":"Sex differences in behavioral and neurochemical effects of gonadectomy and aromatase inhibition in rats","volume":"87","author":"Kokras","year":"2018","journal-title":"Psychoneuroendocrinology"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lim, E.J., Koh, W.U., Kim, H., Kim, H.J., Shon, H.C., and Kim, J.W. (2021). Regional Nerve Block Decreases the Incidence of Postoperative Delirium in Elderly Hip Fracture. J. Clin. Med., 10.","DOI":"10.3390\/jcm10163586"},{"key":"ref_25","first-page":"731","article-title":"Lumbar plexus block combined with general anesthesia in treating postoperative delirium of hip fracture in elderly patients","volume":"36","author":"Xiao","year":"2023","journal-title":"Zhongguo Gu Shang"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Kim, S.Y., Jo, H.Y., Na, H.S., Han, S.H., Do, S.H., and Shin, H.J. (2023). The Effect of Peripheral Nerve Block on Postoperative Delirium in Older Adults Undergoing Hip Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Clin. Med., 12.","DOI":"10.3390\/jcm12072459"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/2\/336\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:34:10Z","timestamp":1760027650000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/2\/336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,14]]},"references-count":26,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["medicina61020336"],"URL":"https:\/\/doi.org\/10.3390\/medicina61020336","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,14]]}}}