Search Results (234)

Postoperative delirium (POD) is a common neurocognitive complication after cardiac surgery in elderly patients and is associated with adverse clinical outcomes. Impaired cerebral autoregulation and reduced cerebrovascular reserve may contribute to POD development. Automated transcranial Doppler sonography (TCD) enables non-invasive assessment of intracranial hemodynamics and may provide additional information for perioperative risk assessment. In this prospective single-center observational study, 108 patients aged >70 years scheduled for elective cardiac surgery with cardiopulmonary bypass were enrolled. Patients who had pre-existing neurological disease, had a pathological carotid Doppler ultrasound, underwent emergency surgery, or were unable to undergo delirium screening were excluded. Preoperative bilateral TCD of the middle cerebral arteries was performed using an automated WAKIe R3 system. POD was assessed on postoperative days 1–3 using the CAM-ICU. The primary endpoint was the occurrence of POD. Twenty-one patients were excluded, leaving 87 patients for analysis. POD occurred in 14 patients (16%). All patients who developed POD had pathological preoperative TCD findings, whereas no POD occurred among patients with normal TCD examinations. Overall, 82 patients (94%) demonstrated pathological intracranial hemodynamic findings despite normal carotid Doppler ultrasound. In multivariable Firth logistic regression adjusted for age and sex, pathological TCD findings remained associated with POD; however, interpretation was limited by the small number of outcome events and quasi-complete separation. In elderly patients undergoing cardiac surgery with cardiopulmonary bypass, pathological preoperative TCD findings were frequently observed and may be associated with an increased risk of postoperative delirium. The marked discrepancy between normal carotid ultrasound and abnormal intracranial hemodynamics suggests that TCD may provide complementary information regarding cerebrovascular function. Given the limited sample size and event rate, these findings should be considered exploratory and require confirmation in larger multicenter studies. Full article

Postoperative delirium (POD) is an acute, reversible neurocognitive disorder characterized by confusion and altered consciousness. With the improvement in research methodologies and the introduction of innovative clinical drugs in recent years, a growing number of randomized controlled trials have been conducted. This article aims to conduct a comprehensive review of the efficacy of general anesthetics—including propofol, ciprofol, sevoflurane, ketamine, esketamine, dexmedetomidine, benzodiazepines, opioids, and lidocaine—in preventing and managing POD, based on randomized controlled trials published in the past five years. Propofol has advantages in preventing POD in pediatric patients. However, its efficacy compared with inhalational anesthetics still requires individualized evaluation in elderly patients. The novel drugs ciprofol and remimazolam exhibit favorable safety profiles and do not increase the risk of POD. The efficacy of dexmedetomidine shows variability across patient populations and surgical types. In addition, specific opioid drugs and lidocaine also demonstrate preventive potential when administered in a standardized manner. Full article

Background and Objectives: We investigate whether a preoperative autonomic vulnerability phenotype and intraoperative regional cerebral oxygen saturation (rcSO₂) variables are associated with postoperative delirium (POD) in elderly patients undergoing non-cardiac, non-neurological surgery, and whether autonomic vulnerability modifies the association between cerebral desaturation and POD. Materials and Methods: This retrospective propensity score–matched cohort study included patients aged 65 years or older who underwent general anesthesia with intraoperative rcSO₂ monitoring. The preoperative autonomic vulnerability phenotype was defined using clinical features documented before surgery, including autonomic neuropathy, diabetic autonomic neuropathy, orthostatic hypotension, syncope or presyncope suggestive of autonomic dysfunction, and unexplained resting bradycardia or chronotropic incompetence not attributable to rate-limiting medication. The primary outcome was POD within 5 postoperative days. Patients were matched 1:1 using nearest-neighbor propensity score matching with a caliper of 0.2 standard deviations of the logit of the propensity score, and conditional logistic regression was used in the matched cohort. Results: A total of 412 patients were included; 112 had the phenotype and 300 did not. After matching, 98 pairs were analyzed. POD occurred in 27.6% of patients with the phenotype and 14.3% of patients without it. In the matched cohort, the phenotype (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.18–3.82, p = 0.012), rcSO₂ decrease ≥20% (OR 2.45, 95% CI 1.31–4.58, p = 0.005), and longer duration of rcSO₂ < 80% of baseline (OR 1.02 per min, 95% CI 1.01–1.04, p = 0.008) were independently associated with POD. The phenotype-by-desaturation interaction was exploratory (OR 2.10, p = 0.032) and was not uniformly robust across sensitivity analyses. Conclusions: A preoperative autonomic vulnerability phenotype and intraoperative cerebral desaturation were independently associated with POD. The association between rcSO₂ decrease and POD appeared stronger in patients with autonomic vulnerability, but this interaction should be interpreted as hypothesis-generating rather than confirmatory. Full article

Background/Objectives: Delirium is a frequent and clinically significant complication in cardiac surgery patients and is associated with prolonged mechanical ventilation, longer Intensive Care Unit (ICU) stay, increased mortality, and long-term cognitive impairment. However, evidence regarding perioperative factors associated with delirium occurrence in cardiac surgery ICU patients remains limited. This study aims to investigate clinical factors associated with postoperative delirium in cardiac surgery patients admitted to the ICU. Methods: A single-center, prospective, observational study was conducted in a 14-bed cardiothoracic ICU in central Italy. Consecutively enrolled adult patients undergoing cardiac surgery were assessed for delirium using the Italian-validated Intensive Care Delirium Screening Checklist (ICDSC) every eight hours for five days. Univariate analysis and multivariate logistic regression were performed to identify factors associated with delirium occurrence. Results: A total of 175 patients were included, and delirium occurred in 44.6%. In the univariate analysis, patients with delirium presented significantly longer mechanical ventilation (10.5 vs. 8.0 h; p = 0.04) and higher APACHE II scores (p = 0.01). In the multivariable analysis, lower Glasgow Coma Scale (GCS) scores were independently associated with delirium occurrence (OR = 0.84; 95% CI: 0.71–0.99; p = 0.04). Urgent admission (OR = 2.02; p = 0.06) and mean arterial pressure (OR = 0.97; p = 0.08) did not reach statistical significance in the multivariable model. Conclusions: Delirium is highly prevalent after cardiac surgery. Lower postoperative GCS scores may represent an early marker of postoperative neurological vulnerability associated with delirium occurrence. Further multicenter studies are warranted to improve delirium risk stratification and clarify the mechanisms underlying postoperative cognitive dysfunction. Full article

Background and Aim: Passive smoking (PS) is a well-established risk factor associated with systemic and oral health impairments in children. However, its influence on perioperative physiological stability and recovery profiles during pediatric dental sedation remains insufficiently elucidated. This study investigated the association between PS exposure and perioperative vital parameters, recovery characteristics, and emergence behavioral outcomes in children undergoing dental extractions under sedation. Methods: This prospective cohort study (ClinicalTrials.gov: NCT06780189) included 100 ASA I children aged 4–6 years scheduled for primary molar extraction under midazolam-remifentanil-propofol sedation. Participants were stratified into three groups: no exposure, caregiver and household exposure, and household exposure only. An exposure-related relationship was evaluated based on daily household cigarette consumption. Perioperative vital signs (HR, blood pressure, and SpO₂) were continuously monitored. Postoperative recovery and emergence profiles were assessed using the Modified Aldrete Recovery Score (MASS), Richmond Agitation–Sedation Scale (RASS), and Pediatric Anesthesia Emergence Delirium (PAED) scale. Results: Children exposed to PS demonstrated significantly lower SpO₂ levels across all perioperative phases compared with non-exposed counterparts (p < 0.001), reflecting an exposure-related effect. In contrast, no statistically significant differences were observed in cardiovascular parameters (p > 0.05). Recovery time was significantly prolonged in PS-exposed children (p = 0.002). Furthermore, PS exposure was associated with significantly higher RASS and PAED scores, indicating increased agitation and emergence delirium (p < 0.001). Conclusions: Passive smoking adversely affects perioperative oxygenation, delays recovery, and exacerbates emergence neurobehavioral disturbances in children undergoing dental sedation. Environmental tobacco exposure must be integrated into preoperative risk assessments. Full article

Background/Objectives: Radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) is associated with high morbidity. Frailty is an important determinant of surgical outcomes; however, its association with the composite outcome Days Alive and Out of Hospital (DAOH) has not been examined following RC. We assessed the impact of preoperative frailty on 90-day DAOH in older patients undergoing RC for MIBC. Methods: We conducted a retrospective cohort study including 408 consecutive patients aged ≥65 years undergoing RC at a tertiary referral center between 2018 and 2023. Frailty was assessed using the record-based Multidimensional Prognostic Index (r-MPI), classifying patients as non-frail (MPI1), moderately frail (MPI2), or severely frail (MPI3). The primary outcome was 90-day DAOH; secondary outcomes included length of stay (LOS), postoperative complications, delirium, and mortality. DAOH was dichotomized at the cohort median. Associations with low DAOH were analyzed using modified Poisson regression with robust variance estimation. Results: Median 90-day DAOH decreased progressively with increasing frailty: MPI1: 81 days (IQR 76–83), MPI2: 73 days (IQR 62–80), MPI3: 67 days (IQR 52–76); p < 0.01. In multivariable analysis, frailty was independently associated with low DAOH (MPI2: RR 2.46, 95% CI 1.94–3.11; MPI3: RR 3.37, 95% CI 2.55–4.46), whereas age and comorbidity were not. Increasing frailty was consistently linked to worse postoperative outcomes, including longer LOS, higher complication burden and severity, and more frequent delirium. Ninety-day postoperative complication-related mortality increased markedly with frailty (MPI1: 1.6%, MPI2: 11.9%, MPI3: 12.1%; p < 0.01). Conclusions: Preoperative frailty is a strong independent predictor of low 90-day DAOH and adverse postoperative outcomes following RC in older patients. Full article

Background/Objectives: Postoperative agitation (PA) and postoperative pain in pediatric patients following sevoflurane anesthesia are challenging clinical scenarios. This study aimed to evaluate the effects of intraoperative dexmedetomidine infusion compared to fentanyl infusion on the prevention of postoperative agitation and analgesic efficacy in children undergoing tonsillectomy and/or adenoidectomy. Methods: After ethical committee approval, a total of 85 pediatric patients (age range: 2–13 years) in the ASA I-II group were included in the study. Patients were randomized into two groups: the dexmedetomidine group (Group D, n = 40) and the fentanyl group (Group F, n = 45). Postoperative pain was monitored in the recovery unit (PACU) using the FLACC (face, legs, activity, cry, consolability) scale, and agitation was monitored using the PAED (pediatric anesthesia emergence delirium) scale. FLACC and PAED were monitored at 5, 10, 15, 30 min, and 2 and 4 h postoperatively. Results: Demographic data and surgical durations were similar between groups (p > 0.05). The dexmedetomidine group had lower FLACC pain scores at 10 and 15 min (uncorrected trends), but only the difference at 30 min remained statistically significant after Bonferroni correction (p = 0.0001; Cohen’s d = 0.85). Although PAED scores were numerically lower in Group D, no statistically significant difference was found. While an observational trend toward lower agitation was noted, it did not reach statistical significance. Extubation times and hemodynamic parameters were similar in both groups. Conclusions: The intraoperative use of dexmedetomidine in tonsillectomy and adenoidectomy procedures provides superior analgesia compared to fentanyl, particularly in the first 30 min postoperatively, without prolonging recovery time. Full article

Background and Objectives: We aimed to determine whether gynecologic cancer–related factors are associated with postoperative clinically significant cognitive decline (CCD) after accounting for age and comorbidity using competing-risk models. Materials and Methods: We performed a retrospective cohort study of adult women undergoing index surgery for gynecologic cancer at a tertiary university hospital. CCD was defined as new clinician-documented cognitive impairment, neurology/psychiatry consultation, or initiation of cognition-targeted pharmacotherapy ≥30 days postoperatively. Competing events were all-cause death and major neurologic events/hospice. We fit Fine–Gray subdistribution hazard models adjusted for age, Charlson Comorbidity Index (CCI), cancer stage, and treatment intensity, and evaluated a prespecified age × stage interaction. Results: Among 1023 eligible patients (mean age 62.4 ± 11.8 years; 41.3% International Federation of Gynecology and Obstetrics [FIGO] stage III–IV; median CCI 3 [IQR 2–5]), CCD occurred in 98 (9.6%). The 12-month cumulative incidence of CCD was 11.2% accounting for competing risks. Advanced stage was independently associated with higher CCD risk (sHR 1.85, 95% CI 1.27–2.69; p = 0.001). A significant age × stage interaction was observed (p < 0.001), with the strongest association in patients ≥70 years (sHR 2.48, 95% CI 1.61–3.81). Perioperative factors associated with CCD included open surgery (sHR 1.54) and postoperative delirium (sHR 2.76); these findings should be interpreted as associative signals rather than validated causal treatment targets. A stratified blinded chart review of 160 patients (80 flagged-positive and 80 unflagged controls) supported the CCD definition (PPV 88.8%; sensitivity 72.1%; specificity 94.3%; NPV 91.5%). Visit-frequency adjustment confirmed robustness (advanced stage sHR 1.78; p = 0.003). Conclusions: Gynecologic cancer–related factors, particularly advanced stage, are independently associated with CCD after accounting for competing risks, and high-risk phenotypes (age ≥70, FIGO III–IV) may benefit from perioperative pathways integrating cognitive screening, delirium prevention, and neurocognitive follow-up. Full article

Background/Objectives: Intraoperative methadone has emerged as a significant pharmacological strategy in cardiac surgery to improve postoperative analgesic outcomes and reduce the reliance on rescue short-action opioids. This review aims to synthesize evidence regarding the safety and efficacy of intravenous methadone compared to other strategies for postoperative pain control in adult and pediatric cardiac surgeries. Methods: This narrative review relied on electronic searches in PubMed, Web of Science, Cochrane Library, and EMBASE up to January 2026. From 199 articles retrieved, 41 were included, focusing on analgesic efficacy, safety, pharmacokinetic variations during cardiopulmonary bypass (CPB), and cost-effectiveness. Results: The implementation of methadone results in up to 70% reduction in postoperative opioid requirements. Patients experience significantly lower pain scores from 24 to 72 h and improvement in satisfaction regarding pain management. In pediatric populations (neonates and children), the use of methadone leads to a significant reduction in opioid needs and a high rate of extubation in the operating room. Pharmacokinetically, a 48% drop in methadone concentration occurs during CPB due to hemodilution and sequestration. Safety data confirms that intraoperative use does not prolong mechanical ventilation; however, doses exceeding 0.25 mg/kg are linked to an increased incidence of delirium. Economically, methadone can be cost-effective, resulting in savings of up to $6355 per patient. Conclusions: Intraoperative methadone improves postoperative analgesia, opioid consumption, patient satisfaction, and costs after cardiac surgery. Its opioid-sparing effects make it particularly attractive for ERAS protocols, although vigilance against dose-related delirium and QT prolongation remains essential. Further research, especially in pediatrics, is needed to refine dosages and safety protocols. Full article

Introduction: Chronic subdural hematoma (CSDH) is a complex disease with an overall incidence of 1.7–20.6 per 100,000 persons per year and is more commonly encountered in the elderly population. It is projected to be one of the most common neurosurgical procedures. Postoperative delirium is a common complication associated with the elderly, causing increased morbidity and prolonged hospital stay. However, its risk factors in chronic subdural hematoma patients have not been well studied. Methods: A total of 202 consecutive patients with chronic subdural hematoma at different neurosurgical centers in Europe between January 2023 and June 2025 were enrolled. Various clinical indicators were analyzed to identify independent risk factors for postoperative delirium using univariate and multivariate regression analyses. Results: Out of the 202 patients (age, 71 (IQR, 18); female-to-male ratio, 1:2.7) studied, 63 (31.2%) experienced postoperative delirium. Univariate analysis identified age (p < 0.001), gender (p = 0.014), restraint belt use (p < 0.001), electrolyte imbalance (p < 0.001), visual analog scale (VAS) pain score (p < 0.001), hematoma thickness (p < 0.001), midline shift (p < 0.001), hematoma side (p = 0.013), hematoma location (p = 0.018), and urinal catheterization (p = 0.028) as significant factors. Multivariate regression analysis confirmed the significance of restraint belt use (B = 7.657, p < 0.001), electrolyte imbalance (B = −3.993, p = 0.001), VAS pain score (B = 2.331, p = 0.016), and midline shift (B = 0.335, p = 0.007). Hematoma thickness and age had no significant impact. Conclusions: Increased midline shift and VAS pain scores, alongside restraint belt use and electrolyte imbalance, elevate delirium risk in chronic subdural hematoma surgery. Our prediction models may offer a reference value in this context. Full article

Background/Objectives: As mounting numbers of older people consider surgery, the importance of aligning treatments with patient values and goals is paramount. This has led to the growth of POPS (Perioperative care of Older Patients) services internationally and across Australia. An observational pilot evaluation of the Melbourne Health POPS service was conducted throughout 2022, with the aims of describing the population, measuring patient-reported outcomes and comparing postoperative outcomes to a matched historical cohort. Methods: Data were sourced from clinical review, electronic medical records and health intelligence. Patients who pursued surgery were matched 2:1 with a 2020 control cohort on up to 10 characteristics ranked on clinical judgement. Patient-reported outcomes were collected at 3 months post-surgery or at the clinic in consenting participants. Results: There were 128 participants, of whom 64 (50%) pursued non-surgical management. Participants were older (median 79 [13] years), frail (median CFS 5 [2]), and multimorbid (median CCI 5 [2.25]). Despite increased perioperative risk amongst the POPS surgical group (ASA-4 23.4% vs. 5.5%, p < 0.001), increased incidence of postoperative delirium (15% vs. 5.8%, p = 0.042) and ICU admission (21.7% vs. 7.5%, p = 0.006) compared to the control group, median length of stay was similar (4.3 [6.7] vs. 4.3 [5.1] days, p = 0.537). Patient-reported outcomes were similar between surgical and non-surgical POPS groups (90.7% vs. 88.1% would make the same surgical decision, p = 0.697). Conclusions: Patients attending POPS were multimorbid with geriatric syndromes and elevated perioperative risk. A high proportion pursued non-operative care. Patient-reported feedback was high with low decisional regret. Full article

Background: The growing number of older adults undergoing surgical procedures requires care models that minimise hospital exposure, optimise safety, and support rapid recovery. Day surgery has become an increasingly attractive option for selected older patients, provided their medical, functional and psychosocial needs are carefully assessed. Recent developments in prehabilitation, geriatric-focused perioperative pathways and enhanced post-discharge follow-up have further expanded its potential. This narrative review aims not only to synthesise current evidence, but also to provide a clinically oriented framework for patient selection, perioperative optimisation, and safe implementation of day surgery pathways in older adults. Main findings: Evidence from the past decade indicates that day surgery can be safe and effective for adults aged ≥65 when supported by structured preoperative assessment, targeted optimisation, and clear discharge criteria. Older patients benefit particularly from reduced risks of hospital-acquired complications, including infection, delirium, immobility and functional decline. Prehabilitation programmes focusing on nutrition, strength, balance and medication review are associated with improved postoperative stability and faster return to baseline function. Multidisciplinary teamwork, integrating surgeons, anaesthetists, geriatricians, nurses, physiotherapists, dietitians and caregivers, play a key role in identifying modifiable risks and ensuring continuity of care. Studies also highlight the value of post-discharge telephone follow-up, caregiver engagement and close collaboration with primary care in preventing readmissions. Conclusions: Day surgery is a viable and patient-centred option for many older adults when careful selection and preparation are combined with age-sensitive perioperative care. Most adverse outcomes can be mitigated through systematic prehabilitation, thoughtful anaesthetic planning, early mobilisation and structured follow-up. The evidence suggests that older patients may benefit from reduced hospital stay, less exposure to harm, and faster functional recovery. Implications for practice: The findings support broader integration of geriatric day surgery into routine care pathways, especially within health systems facing capacity constraints. Clinicians should consider implementing standardised geriatric assessment, multidisciplinary optimisation strategies, and robust discharge and follow-up protocols to enhance safety and effectiveness. With appropriate preparation and coordinated teamwork, day surgery can contribute meaningfully to safer, more efficient and more patient-centred surgical care for older adults. Full article

Cataracts represent the leading cause of blindness worldwide, particularly in older adults, and constitute a significant public health challenge. Although cataract surgery is generally associated with a high safety profile, both patients and healthcare providers often face significant challenges due to age-related physiological changes and the high prevalence of comorbidities, which are directly linked to cataractogenesis and other systemic diseases that can complicate both the surgical procedure and postoperative recovery. This narrative review aimed to assess the epidemiological characteristics of age-related physiological and pathological comorbidities in older adults with cataracts, evaluating their impact on preoperative assessment, surgical outcomes, and public health planning. Articles were identified through non-systematic searches of PubMed, EMBASE, and Scopus using a combination of medical subject headings (MeSH) terms and free-text keywords. Among the multiple non-ocular comorbidities, carotid artery disease (CAD) and hypertension (HTN) are among the cardiovascular diseases (CVDs) with the highest correlations with cataract. Diabetes, dyslipidemia, and metabolic syndrome are also highly prevalent and significantly influence surgical outcomes, as poor glycemic control increases intraoperative risks and postoperative complications. Additionally, neurological conditions such as stroke, Parkinson’s disease, and epilepsy often complicate anesthesia administration, contribute to postoperative delirium, and affect adherence to treatment protocols. Given these complexities, a multidisciplinary approach and targeted preoperative screening may offer personalized care to improve safety and outcomes. Despite advances in clinical care, disparities in access to cataract surgery, especially in underserved populations, continue to exist. Thus, a coordinated public health strategy that promotes early detection, equitable access, and the integration of innovations such as teleophthalmology and artificial intelligence is essential to optimize care for older adults with cataracts worldwide. Full article

Background: Cemented and cementless fixation techniques in total hip arthroplasty (THA) each present distinct biomechanical properties and perioperative risk profiles. While cementless fixation has gained increasing popularity, large-scale nationally representative comparisons of perioperative outcomes between cemented and cementless elective THA remain limited. This study aimed to compare complication rates, healthcare utilization, and temporal trends between cemented and cementless elective THA using the National Inpatient Sample. Methods: A retrospective cohort study was conducted using the National Inpatient Sample database from 2016 to 2021. Adult patients undergoing elective primary total hip arthroplasty were identified using ICD-10-PCS codes and categorized into cemented and cementless fixation groups. Patient demographics, comorbidities, indications, postoperative complications, length of stay, hospital charges, and in-hospital mortality were compared. Multivariate logistic regression analysis was performed to evaluate the independent association between fixation type and postoperative complications while adjusting for demographic, clinical, and hospital-level variables. Results: A total of 81,668 elective THAs were identified, including 40,290 cemented (49.33%) and 41,378 cementless (50.67%) procedures. Cemented THA was associated with a shorter length of stay (2.09 ± 1.88 vs. 2.26 ± 2.47 days, p < 0.001) and lower total hospital charges ($65,584.53 ± 48,797.21 vs. $72,186.84 ± 49,860.20, p < 0.001). Unadjusted analyses demonstrated higher rates of acute kidney injury and sepsis in the cementless group. After multivariate adjustment, cemented fixation was associated with lower odds of acute kidney injury (OR 0.87, 95% CI 0.79–0.96, p = 0.004). However, cemented THA was associated with higher odds of postoperative delirium (OR 1.20, 95% CI 1.02–1.42, p = 0.030), blood transfusion (OR 1.27, 95% CI 1.17–1.37, p < 0.001), and periprosthetic fracture (OR 1.32, 95% CI 1.02–1.71, p = 0.035). Rates of myocardial infarction, pneumonia, venous thromboembolism, urinary tract infection, and in-hospital mortality were similar between groups. Temporal analysis demonstrated comparable utilization trends, with a decline in elective procedures during 2020–2021. Conclusions: In this nationwide analysis, cemented total hip arthroplasty was associated with lower risk of acute kidney injury, shorter length of stay, and lower hospital charges, but higher odds of postoperative delirium, blood transfusion, and periprosthetic fracture compared with cementless fixation. These findings highlight distinct perioperative risk profiles between fixation strategies and may assist surgeons in individualized decision-making for elective total hip arthroplasty. Full article

Background: While providing enough sedatives to avoid pain and trauma during surgery is important, studies show a link between the received sedatives and the development of postoperative delirium (POD). Therefore, predicting POD from clinical or physiological data before or during surgery is highly advantageous. This capability enables healthcare providers to proactively implement necessary measures, thereby mitigating or preventing potential complications. Methods: In this study, we focus on patients with Parkinson’s disease undergoing deep brain stimulation surgery who are particularly susceptible to POD. We investigate what aspects of EEG’s power, functional connectivity and complexity during the course of the surgery are influenced by the amount of sedative. Furthermore, we aim to determine whether and to what extent the recorded brain activity during surgery can serve as a reliable means for the prediction of POD in this group of patients. Results and Conclusions: Our results show significant correlations between various power, connectivity and complexity features of EEG and the amount of sedatives. Even though single EEG features are not significantly different between the two groups who either developed or did not develop POD, we show that a classifier based on support vector machines using the selected EEG features could predict POD. Furthermore, our results provide evidence that a classifier trained only on the amount of sedatives is unable to predict POD. Accompanying this paper, our code is published as an open-source toolbox for the analysis of the EEG signal recorded with the four-channel SEDLine Root system, which is among the widely used EEG systems in operation rooms and its recorded data come with challenges that are addressed in our toolbox. Full article