Clinical effectiveness of intraoperative continuous pump infusion of remimazolam on postoperative delirium in elderly patients with hip fractures

Postoperative delirium (POD) is a prevalent acute central nervous system complication in elderly patients following surgery. The potential of remimazolam, a novel ultrashort-acting benzodiazepine, in mitigating POD after hip fracture surgery remains unclear. The present study aimed to investigate the effects of continuous intraoperative remimazolam infusion on POD in elderly patients with hip fractures undergoing subarachnoid block. A retrospective analysis was conducted on 405 elderly patients who underwent elective hip fracture surgery under subarachnoid block at The 904th Hospital of the Joint Logistics Support Force (Wuxi, China) between January 2019 and December 2023. Patients were divided into two groups based on the intervention received: The remimazolam group (observation group, n=180) and the control group (no remimazolam treatment, n=225). POD was evaluated using the Confusion Assessment Method-Chinese Revision at 1-7 days post-surgery. Anxiety scores were recorded 1 day before and 1 day after surgery. The incidence of intraoperative hypertension, hypotension, bradycardia, hypoxemia, and postoperative nausea and vomiting was also documented. Baseline characteristics were comparable between the two groups, with no significant differences observed in patient demographics. The incidence of POD was significantly lower in the remimazolam group compared with that in the control group (P=0.008). Anxiety scores 1 day post-surgery were also significantly reduced in the remimazolam group (P<0.001). Furthermore, the remimazolam group demonstrated a marked reduction in intraoperative hypertension (P=0.017). No significant differences were observed between the two groups regarding the incidences of intraoperative hypotension, bradycardia, hypoxemia, or postoperative nausea and vomiting. In conclusion, remimazolam appears to reduce the incidence of POD in elderly patients undergoing hip fracture surgery with subarachnoid block, potentially through the alleviation of intraoperative anxiety, without increasing the risk of perioperative complications.