- Design
- Pragmatic, multicentre, open-label randomised trial
- Population
- 2,508 adults aged 50 and over having major non-cardiac surgery, 49 UK hospitals
- Primary outcome
- Days alive and at home at 30 days
- Effect
- 22.5 vs 22.4 days; IRR 1.00 (0.99 to 1.02)
This pragmatic, open-label trial randomised 2,508 patients aged 50 or older (mean 67) having elective major non-cardiac surgery in 49 NHS hospitals to maintenance with total intravenous anaesthesia (propofol) or volatile anaesthesia.
Days alive and at home at 30 days were identical (22.5 vs 22.4; incidence rate ratio 1.00, 95% CI 0.99 to 1.02). There were no differences at 90 days, in mortality to six months, in quality of recovery, in delirium at day 3 (87.6% delirium-free overall), or in major complications (12.4% overall). TIVA reduced thirst, hoarseness and nausea and vomiting. Two cases of awareness occurred, both with TIVA.
For older surgical patients, the maintenance agent is not a lever for delirium or recovery. Attention is better spent on the factors that do matter — pain, sleep, mobility, hydration and medication review.
- Choice between propofol and volatile anaesthesia did not change recovery or delirium in older patients
- TIVA reduces postoperative nausea and vomiting, which matters for some patients
- Use processed EEG monitoring with TIVA to reduce awareness risk
- Focus delirium prevention on non-anaesthetic factors: orientation, sleep, mobility, hydration, drugs
Why it matters
It removes the anaesthetic agent from the list of delirium-prevention priorities.
The statistics, in plain English
An incidence rate ratio of 1.00 with a narrow interval (0.99 to 1.02) means the trial excludes any meaningful difference in days at home.
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