Lv BS, Wang W, Jin M, Ma Y, Wang JL, Gao H. Impact of oxiracetam on postoperative delirium in elderly patients undergoing laparoscopic gastrointestinal surgery. World J Gastrointest Surg 2026; 18(4): 119293 [DOI: 10.4240/wjgs.v18.i4.119293]
Corresponding Author of This Article
Wei Wang, MD, Department of Neurology, Hebei Yanda Hospital, Yanjiao Development Zone, Langfang 065201, Hebei Province, China. ww19333643617@163.com
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Pharmacology & Pharmacy
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Prospective Study
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Apr 27, 2026 (publication date) through Apr 24, 2026
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Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Lv BS, Wang W, Jin M, Ma Y, Wang JL, Gao H. Impact of oxiracetam on postoperative delirium in elderly patients undergoing laparoscopic gastrointestinal surgery. World J Gastrointest Surg 2026; 18(4): 119293 [DOI: 10.4240/wjgs.v18.i4.119293]
World J Gastrointest Surg. Apr 27, 2026; 18(4): 119293 Published online Apr 27, 2026. doi: 10.4240/wjgs.v18.i4.119293
Impact of oxiracetam on postoperative delirium in elderly patients undergoing laparoscopic gastrointestinal surgery
Bao-Sheng Lv, Wei Wang, Mu Jin, Yan Ma, Jia-Lu Wang, Hui Gao
Bao-Sheng Lv, Yan Ma, Jia-Lu Wang, Hui Gao, Department of Anesthesiology, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
Wei Wang, Department of Neurology, Hebei Yanda Hospital, Langfang 065201, Hebei Province, China
Mu Jin, Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Author contributions: Lv BS and Wang W concepted and designed the study; Jin M, Ma Y, Wang JL and Gao H collected and analyzed the data; Lv BS wrote the manuscript. All authors have read and approved the final manuscript.
Supported by Natural Science Foundation of Hebei Province, No. H2021103001.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Hebei Yanda Hospital, No. 2021-3-008.
Clinical trial registration statement: The study protocol was registered in the Chinese Clinical Trial Registry, No. ChiCTR2300076112.
Informed consent statement: Written informed consent was obtained from all patients or their legal guardians.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Wei Wang, MD, Department of Neurology, Hebei Yanda Hospital, Yanjiao Development Zone, Langfang 065201, Hebei Province, China. ww19333643617@163.com
Received: January 27, 2026 Revised: February 12, 2026 Accepted: March 10, 2026 Published online: April 27, 2026 Processing time: 88 Days and 1 Hours
Abstract
BACKGROUND
Postoperative delirium (POD) is common in older surgical patients and increases morbidity and mortality. Oxiracetam, a nootropic agent, has not been evaluated for POD prevention.
AIM
To assess the efficacy of perioperative oxiracetam in reducing POD incidence.
METHODS
In this multicenter, randomized, double-blind, placebo-controlled trial, a total of 173 elderly patients (age ≥ 65 years) scheduled for elective laparoscopic gastrointestinal surgery were enrolled and randomly assigned to the oxiracetam group (OG, n = 82) or the normal saline control group (SG, n = 91). The OG received intravenous Oxiracetam (4.0 g/day) from 30 minutes before anesthesia induction and for 6 consecutive days postoperatively, while the SG received an equal volume of normal saline. The primary outcome was the incidence of POD within 7 days postoperatively. Secondary outcomes included changes in perioperative cognitive function and dynamic levels of a panel of inflammatory factors.
RESULTS
POD incidence was lower in the OG [13.4% (11/82)] than in the placebo group [28.6% (26/91)] (P < 0.01). Oxiracetam remained an independent protective factor after multivariate adjustment (adjusted odds ratio = 0.12, 95% confidence interval: 0.04-0.36, P < 0.01). The OG also showed better preservation of cognitive function (Montreal Cognitive Assessment score). Inflammatory profiling revealed a distinct immunomodulatory pattern: Oxiracetam attenuated postoperative rises in interleukin (IL)-6, IL-8, and IL-1β while enhancing levels of IL-10 and IL-2.
CONCLUSION
Perioperative oxiracetam significantly reduces POD risk and preserves cognitive function in elderly surgical patients, potentially through a multi-target immunomodulatory mechanism rather than simple anti-inflammation.
Core Tip: Perioperative intravenous oxiracetam safely and effectively reduces the risk of postoperative delirium in elderly patients undergoing laparoscopic gastrointestinal surgery, and maintains postoperative cognitive functionality. Its protective effect likely involves multi-target mechanisms, including stabilization complex modulation of the systemic immune response, rather than dependence on simple suppression of a single inflammatory pathway. This study provides a foundation for the clinical application of oxiracetam as a perioperative brain protection strategy for elderly surgical patients.
