PROSEVO Trial (Propofol-Sevoflurane Delirium Target Trial Emulation)

This retrospective, single-center cohort study analyzes routine data from Charité - Universitätsmedizin Berlin and its clinical partners for the period from January 1, 2011, to January 31, 2026.

Inclusion criteria

• Adult patients (≥18 years) at the Department of Anesthesiology and Intensive Care Medicine (CCM/CVK) and the Department of Anesthesiology and Intensive Care Medicine (CBF) at Charité,
• undergoing elective surgery under general anesthesia
• with a planned surgery duration of ≥ 30 minutes

In addition, the following conditions must be met:

• The surgery must be the patient's first surgery per hospital stay to avoid dependencies and repeated measurements of the same person within a short time frame;
• The surgeries take place at Charité between January 1, 2011, and December 31, 2025.

Exclusion criteria

Patients in any of the following situations are excluded:

• Cardiac surgery (this patient group requires specialized monitoring strategies and has postoperative delirium risk profiles that differ significantly from those of other types of surgery)
• preoperatively diagnosed delirium, defined as positive results on the Nursing Delirium Screening Scale (NU-DESC) or the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) during preoperative evaluations;
• severe preoperative cognitive impairment, defined as a Mini-Mental State Examination (MMSE) score <15 points, or
• preoperatively documented severe dementia
• neurosurgical procedures (neurosurgical patients require specialized monitoring protocols and differ from other surgical patients in their postoperative delirium (POD) symptoms)
• Patients who were already admitted to intensive care units prior to their elective surgery (these patients already have increased mortality and a different risk profile)
• Patients who were already intubated or sedated prior to surgery (this group cannot undergo standardized POD screening)
• High preoperative risk for postoperative nausea and vomiting (PONV) (specifically, patients with documented PONV grade 3 or PONV grade 4 risk are excluded, as this group is indicated for anesthesia with propofol)