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已发表论文
术前焦虑与术后谵妄：关联、机制和预防策略的迷你综述
Received 2 September 2025
Accepted for publication 13 January 2026
Published 22 January 2026 Volume 2026:19 564668
DOI https://doi.org/10.2147/JMDH.S564668
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 6
Editor who approved publication: Dr David C. Mohr
Qiang Wang, Genfeng Ding, Yu Li
Department of Anesthesiology and Surgery, First People’s Hospital of Yong Kang, Yong Kang, Zhejiang, 321300, People’s Republic of China
Correspondence: Qiang Wang, Email xinxin321nm@163.com
Abstract: Preoperative anxiety, a common perioperative psychological state characterized by restlessness and somatic symptoms, has been reported to affect a broad range of adult surgical patients, with prevalence estimates ranging from approximately 11% to 80% across observational studies, and affects a similar proportion of pediatric patients, with one cross sectional study reporting an incidence of around 67.6% in Chinese children undergoing elective surgery. Mounting evidence suggests that preoperative anxiety may be a potential contributing factor to postoperative delirium (POD), an acute cognitive disturbance associated with poor prognosis, increased mortality, and elevated healthcare costs. This mini-review synthesizes the role of preoperative anxiety in predicting POD, highlighting its significance in identifying high-risk populations. This mini-review aims to synthesize current evidence on the impact of preoperative anxiety on POD, clarify underlying pathophysiological mechanisms, and summarize recent pharmacological and non-pharmacological preventive strategies. Mechanistically, preoperative anxiety contributes to POD via systemic and neuroinflammatory responses, blood-brain barrier disruption, postoperative pain amplification, and oxidative stress. Pharmacological interventions (eg, dexmedetomidine, ketamine in pediatric patients) and non-pharmacological strategies (eg, music therapy, virtual reality-based cognitive-behavioral interventions) effectively alleviate preoperative anxiety and reduce POD incidence. Despite progress, the mechanisms linking preoperative anxiety to POD remain incompletely understood, particularly the roles of neuroinflammatory pathways, blood–brain barrier disruption, and the comparative effectiveness of pharmacological versus non-pharmacological interventions. Targeted research in these areas is needed to optimize preventive strategies and improve surgical outcomes.
Keywords: delirium, postoperative cognitive complications, perioperative care, preoperative anxiety, preventive strategies, surgery
Department of Anesthesiology and Surgery, First People’s Hospital of Yong Kang, Yong Kang, Zhejiang, 321300, People’s Republic of China
Correspondence: Qiang Wang, Email xinxin321nm@163.com
Abstract: Preoperative anxiety, a common perioperative psychological state characterized by restlessness and somatic symptoms, has been reported to affect a broad range of adult surgical patients, with prevalence estimates ranging from approximately 11% to 80% across observational studies, and affects a similar proportion of pediatric patients, with one cross sectional study reporting an incidence of around 67.6% in Chinese children undergoing elective surgery. Mounting evidence suggests that preoperative anxiety may be a potential contributing factor to postoperative delirium (POD), an acute cognitive disturbance associated with poor prognosis, increased mortality, and elevated healthcare costs. This mini-review synthesizes the role of preoperative anxiety in predicting POD, highlighting its significance in identifying high-risk populations. This mini-review aims to synthesize current evidence on the impact of preoperative anxiety on POD, clarify underlying pathophysiological mechanisms, and summarize recent pharmacological and non-pharmacological preventive strategies. Mechanistically, preoperative anxiety contributes to POD via systemic and neuroinflammatory responses, blood-brain barrier disruption, postoperative pain amplification, and oxidative stress. Pharmacological interventions (eg, dexmedetomidine, ketamine in pediatric patients) and non-pharmacological strategies (eg, music therapy, virtual reality-based cognitive-behavioral interventions) effectively alleviate preoperative anxiety and reduce POD incidence. Despite progress, the mechanisms linking preoperative anxiety to POD remain incompletely understood, particularly the roles of neuroinflammatory pathways, blood–brain barrier disruption, and the comparative effectiveness of pharmacological versus non-pharmacological interventions. Targeted research in these areas is needed to optimize preventive strategies and improve surgical outcomes.
Keywords: delirium, postoperative cognitive complications, perioperative care, preoperative anxiety, preventive strategies, surgery