Effect of parecoxib on postoperative delirium in patients with hyperlipidemia: a randomized, double-blind, single-center, superiority trial.

Summary

Among 452 adults with hyperlipidemia, pre-induction parecoxib (40 mg IV) reduced postoperative delirium from 26.1% to 13.7% (HR 0.491; P<0.001). Emergence delirium, COX-2 expression, leukocyte counts, and day-1 pain scores were lower versus placebo, with similar adverse events.

Key Findings

• Parecoxib reduced postoperative delirium incidence by 12.39% absolute compared with placebo (13.72% vs 26.11%; HR 0.491; P<0.001).
• Lower emergence delirium, COX-2 expression, leukocyte/neutrophil counts, and postoperative day-1 pain scores in the parecoxib group.
• Adverse events were comparable between groups; mediation analyses implicated inflammation and pain control in delirium reduction.

Clinical Implications

Consider pre-induction parecoxib as part of multimodal, opioid-sparing analgesia and delirium prevention for adults with dyslipidemia, while balancing contraindications to COX-2 inhibitors.

Limitations

• Single-center trial; generalizability to other populations and surgeries uncertain.
• Short delirium surveillance window (first 3 days) without long-term cognitive follow-up.

Future Directions

Multicenter trials across diverse surgeries to confirm efficacy/safety, evaluate optimal dosing/timing, and assess long-term cognitive and functional outcomes.