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Comparative effects of fentanyl, morphine, and hydromorphone on postoperative delirium and outcomes after cardiac surgery: a propensity score-matched cohort study

Year: 2025

Type: article

Abstract: Postoperative delirium (POD) significantly increases mortality and medical burden, however, evidence regarding the best opioid options after cardiac surgery remains limited.Using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, we identified 8246 adult patients receiving > 70% of postoperative 24-h morphine milligram equivalents (MMEs) during the ICU length of stay as fentanyl, morphine, or hydromorphone. After 1:1:1 propensity score matching (PSM) (n = 701 per group), we compared POD incidence, mortality, length of stay, vasopressor- and ventilator-free days within 28 days.The matched cohort of 2103 patients showed balanced baseline characteristics (all SMD < 0.1). POD incidence was significantly lower in the morphine (10.6%) and hydromorphone (9.7%) groups than in the fentanyl group (22.1%). The hydromorphone group was associated with significantly lower rates of ICU (OR 0.07, 95% CI 0.01-0.53) and hospital mortality (OR 0.25,95% CI 0.08-0.74), as well as shorter ICU and hospital length of stay, and more vasopressor- and ventilator-free days within 28 days. Hydromorphone was associated with a significantly lower incidence of POD, lower mortality, shorter length of stay, and more vasopressor- and ventilator-free days within 28 days. Whereas morphine was also associated with a reduced risk of delirium and shorter length of stay, it was not significantly associated with a reduction in mortality.

Source: Scientific Reports

DOI: 10.1038/s41598-025-29805-6