{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T11:04:47Z","timestamp":1793271887281,"version":"4.5.0"},"reference-count":27,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"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 common complication in elderly patients undergoing major surgery, associated with systemic inflammation and potentially influenced by anesthetic techniques. This study investigated whether remimazolam-based total intravenous anesthesia (R-TIVA) reduces the level of systemic inflammatory biomarkers and the incidence of POD more compared to inhalational anesthesia (IA) or balanced anesthesia (BA) in patients aged \u2265 65 years undergoing major non-neurosurgical, non-cardiac surgery. Materials and Methods: This retrospective cohort study analyzed the medical records of 340 patients categorized by anesthesia type: R-TIVA (n = 111), IA (n = 117), or BA (n = 112). Propensity score matching (PSM) created POD (n = 104) and No POD (n = 106) cohorts. Systemic inflammatory biomarkers\u2014the systemic immune\u2013inflammation index (SII), the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP)\u2014were measured pre- and postoperatively. POD was identified by clinical symptoms or the postoperative use of antipsychotics\/sedatives. Results: The incidence of POD did not significantly differ among the R-TIVA, IA, and BA groups. However, the postoperative SII, NLR, PLR, and CRP levels were significantly lower in the R-TIVA group compared to those in the IA group (p &lt; 0.05). Both the preoperative (rpb = 0.72, p &lt; 0.01) and postoperative (rpb = 0.58, p &lt; 0.01) NLRs were strongly correlated with POD. Higher NLR values predicted the incidence of POD, with odds ratios of 1.71 for preoperative and 1.32 for postoperative measurements. Conclusions: While R-TIVA did not significantly reduce the incidence of POD compared to that of IA or BA, it was associated with reduced levels of postoperative inflammatory biomarkers. The preoperative and postoperative NLRs emerged as strong predictors of POD, suggesting their potential utility in guiding prophylactic strategies for older surgical patients. These findings underscore the interplay between anesthesia type, systemic inflammation, and delirium risk.<\/jats:p>","DOI":"10.3390\/medicina61061023","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T03:19:38Z","timestamp":1748834378000},"page":"1023","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Remimazolam-Based Anesthesia and Systemic Inflammatory Biomarkers in Relation to Postoperative Delirium in Elderly Patients: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"61","author":[{"given":"Hayoung","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan-si 54538, Jeonbuk, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keunyoung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Division of Coloproctology, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan-si 54538, Jeonbuk, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2472-2908","authenticated-orcid":false,"given":"Cheol","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan-si 54538, Jeonbuk, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"351","DOI":"10.2147\/CIA.S2759","article-title":"Postoperative delirium in the elderly: Diagnosis and management","volume":"3","author":"Robinson","year":"2008","journal-title":"Clin. 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