Prehabilitation is associated with a reduced incidence of postoperative delirium in patients undergoing pancreatoduodenectomy: a propensity score-matched cohort study

BACKGROUND: Delirium is a common complication following pancreatic surgery and negatively influences postoperative recovery. Prehabilitation may reduce postoperative delirium, potentially by attenuating systemic inflammation. METHODS: In this retrospective propensity score-matched cohort study, patients undergoing pancreatoduodenectomy who received prehabilitation were compared to an historical control cohort. Delirium was assessed using a validated chart-based method based on DSM-5 criteria. Primary outcome was the association between prehabilitation and postoperative delirium. Secondarily, the association with pre- and postoperative C-reactive protein (CRP) and leukocyte levels was assessed. RESULTS: In total, 239 patients were included, comprising 119 in the historical and 120 in the prehabilitation cohort. Delirium occured in 26 historical patients (21.2%) versus 12 (10.0%) in the prehabilitation cohort, p = 0.014. After adjusting for age and major complications, prehabilitation remained significantly associated with reduced odds ratio of delirium (OR 0.338, 95%-CI 0.154-0.743, p = 0.007). CRP was significantly lower on postoperative day 1 in the prehabilitation cohort (83.0 vs 94.0 mg/L, p = 0.005), but not preoperatively and on postoperative day 2 and 3. Leukocyte levels did not differ between cohorts. CONCLUSION: Prehabilitation is associated with a significantly lower incidence of delirium following pancreatoduodenectomy, independent of age or major complications. Although CRP was lower on postoperative day 1 in the prehabilitation cohort, this difference did not persist. These findings support the prehabilitation as a promising delirium prevention strategy in surgical patients, warranting further research on the underlying mechanisms.