TY  - JOUR
AU  - Nobuhara, Chloe K.
AU  - Suh, Elijah
AU  - Lee, Alex H.
AU  - Fung, Ethan
AU  - Masarweh, Ghazal
AU  - Forrester, Joseph D.
PY  - 2026
TI  - Comparative outcomes of post-operative delirium after video-assisted thoracoscopic, robotic, and open thoracic surgery: a narrative review
JF  - Video-Assisted Thoracic Surgery; Online First
Y2  - 2026
KW  - 
N2  - Background and Objective: Post-operative delirium (POD) is a common complication following thoracic surgery in older adults, associated with increased morbidity, mortality, and cognitive decline. While minimally invasive surgery (MIS), including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS), is hypothesized to reduce POD risk, direct comparisons with open thoracotomy remain rare. This narrative review synthesizes current evidence to evaluate the association between surgical approach and POD risk within the multifactorial causes of delirium in geriatric patients.Methods: A structured literature search was conducted across PubMed, Scopus, Embase, and Web of Science from database inception through January 29, 2026. Inclusion criteria comprised of English-language randomized controlled trials, prospective and retrospective cohort studies, cross-sectional analyses, and case series across POD outcomes across VATS, RATS, and open thoracic procedures. Case reports, non-English studies, and non-comparative reviews were excluded.Key Content and Findings: The primary outcome was POD incidence by operative approach; secondary outcomes included pain scores, opioid requirements, and blood transfusions. Evidence from large-scale thoracic procedures demonstrates that open thoracotomy is associated with a statistically significant higher POD incidence compared to MIS. VATS and RATS attenuate the perioperative physiological toll by reducing major tissue trauma, blood loss, and severe nociceptive burden, subsequently lowering reliance on deliriogenic opioids. However, varying delirium assessment methodologies and the frequent pooling of VATS and RATS obscure direct modality comparisons.Conclusions: Minimally invasive techniques may be associated with a reduced risk of POD. Clinically, the surgical approach should be integrated as a central enabling variable within multidisciplinary Enhanced Recovery After Surgery (ERAS) pathways for older adults. Future research requires multicenter, prospective trials utilizing standardized delirium assessment tools [e.g., Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)] and objective biomarkers to definitively establish mechanistic pathways.
UR  - https://vats.amegroups.org/article/view/13447