Development and preliminary evaluation of a Neuman Systems Model–based protocol for postoperative delirium prevention in patients undergoing pancreatic cancer surgery

Vollständiger Abstract

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This study aimed to develop and evaluate a Neuman Systems Model–based protocol for the prevention and management of postoperative delirium in patients undergoing surgery for pancreatic cancer. The protocol was developed through literature review and a modified Delphi process, and its clinical effectiveness was assessed in a single-center study using a historical control design. A total of 120 patients who underwent radical resection for pancreatic cancer between January 2024 and December 2025 were included, with 60 patients in the control group and 60 in the intervention group. Compared with the control group, the intervention group had a significantly lower incidence of postoperative delirium (10.0% vs 26.7%, P = .018), lower peak Confusion Assessment Method-S scores, shorter delirium duration, and a lower overall incidence of delirium-related adverse events. The intervention group also showed better quality of life scores at 1 and 3 months after surgery, lower depression, anxiety, and stress scores at postoperative day 7, better postoperative recovery indicators, and higher nursing satisfaction. Supplementary analyses identified age ≥70 years, preoperative sleep disturbance, postoperative electrolyte imbalance, postoperative infection, and preoperative risk of malnutrition as independent factors associated with postoperative delirium. These findings suggest that the Neuman Systems Model–based protocol may help reduce the incidence and severity of postoperative delirium and improve selected postoperative outcomes in patients with pancreatic cancer, although further validation in larger multicenter studies is needed.