Effect of preoperative transcranial direct current stimulation on postoperative delirium in elderly patients following laparoscopic surgery

doi:10.5498/wjp.v15.i10.107298

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World Journal of Psychiatry

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2220-3206

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Clinical Trials Study

World J Psychiatry. Oct 19, 2025; 15(10): 107298
Published online Oct 19, 2025. doi: 10.5498/wjp.v15.i10.107298

Effect of preoperative transcranial direct current stimulation on postoperative delirium in elderly patients following laparoscopic surgery

Li-Ping Chen, Ye-Ju Hu, Xue-Yao Li, Wen-Di Tian, Chen-Hui Ye, Yu-Fei Wei, Xi Yang

Xi Yang, Yu-Fei Wei, Chen-Hui Ye, Wen-Di Tian, Xue-Yao Li, Ye-Ju Hu, Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China

Yu-Fei Wei, Chen-Hui Ye, Wen-Di Tian, Xue-Yao Li, Ye-Ju Hu, Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China

Li-Ping Chen, Department of Pain Management, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China

Co-first authors: Xi Yang and Yu-Fei Wei.

Author contributions: Yang X and Wei YF conceptualized and designed the research, they contributed equally to this article, they are the co-first authors of this manuscript; Ye CH and Tian WD performed the literature search, analyzed the data; Li XY and Hu YJ wrote the original manuscript; Chen LP edited the final manuscript; and all authors have read and approved the final manuscript.

Institutional review board statement: This study was approved by the Medical Ethics Committee of the Affiliated Hospital of Xuzhou Medical University, approval No. XYFY2024-KL026-01.

Clinical trial registration statement: This study is registered at http://www.chictr.org.cn/. The registration identification, approval No. ChiCTR2400087975.

Informed consent statement: All study participants provided informed written consent before enrollment.

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 from this study are available upon reasonable request from the corresponding authors at cpdw521@163.com.

Corresponding author: Li-Ping Chen, MD, Chief Physician, Department of Pain Management, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou 221002, Jiangsu Province, China. cpdw521@163.com

Received: March 30, 2025
Revised: May 13, 2025
Accepted: July 18, 2025
Published online: October 19, 2025
Processing time: 180 Days and 16.1 Hours

Abstract

BACKGROUND

Postoperative delirium (POD), an acute neuropsychiatric complication in elderly surgical patients, manifests as attention and cognitive disturbances that may last 24-72 hours after surgery, potentially progressing to dementia. Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique, enhances cortical excitability and cognitive function by modulating brain networks and synaptic plasticity. Elderly patients undergoing major laparoscopic surgery face elevated POD risks due to prolonged anesthesia and pneumoperitoneum-induced cerebral hypoperfusion. This study investigates whether pre-anesthesia tDCS can reduce POD incidence in this population.

AIM

To investigate the effect of preoperative tDCS on reducing the incidence of POD in elderly patients undergoing major laparoscopic surgery.

METHODS

In this study, we enrolled 220 elderly patients who underwent major laparoscopic surgery between April 2024 and December 2024. Patients were randomly assigned to the active-tDCS (group A) and sham-tDCS (group S) groups. A single session of tDCS or sham stimulation was administered 30 minutes before anesthesia induction. The primary outcome was the incidence of POD during within 3 days postoperatively.

RESULTS

A total of 201 patients were included in the final analysis, with 100 patients in group A and 101 in group S. The incidence of POD within 3 days postoperatively was 7.0% in group A, which was significantly lower than 22.8% in group S. On postoperative day 1, the Self-Rating Anxiety Scale and Self-Rating Depression Scale scores significantly differed between the two groups, but the pain scores showed no significant difference.

CONCLUSION

A single session of preoperative tDCS can reduce the incidence of POD in elderly patients undergoing major laparoscopic surgery and can also reduce postoperative anxiety and depression in these patients.

Keywords: Transcranial direct current stimulation; Postoperative delirium; Cognition; Laparoscopic surgery; Randomized controlled trial

Core Tip: A single session of preoperative transcranial direct current stimulation (tDCS) significantly reduces the incidence of postoperative delirium (POD) in elderly patients undergoing major laparoscopic surgery, with a POD rate of 7.0% in the tDCS group compared to 22.8% in the sham group. In addition, tDCS significantly reduces postoperative anxiety and depression but not pain. These findings uphold preoperative tDCS as a promising intervention for preventing POD and enhancing psychological recovery in elderly surgical patients.