Triglyceride-glucose index and postoperative delirium: a retrospective study exploring a lipid-related marker in neuropsychiatric risk stratification after gastric surgery.

BACKGROUND: Delirium is a common neuropsychiatric complication following major gastrointestinal surgery and is associated with poor postoperative outcomes. Patients undergoing gastric surgery often experience significant metabolic stress and insulin resistance, which may contribute to delirium. The triglyceride-glucose (TyG) index is a simple surrogate marker of insulin resistance, but its predictive value for postoperative delirium in gastric surgery patients remains unclear. METHODS: This retrospective study used data from the MIMIC-IV database and included 819 ICU patients after gastric surgery. Exposure was the triglyceride-glucose (TyG) index from first available labs; outcome was ICU delirium assessed by CAM-ICU. Associations were examined with multivariable logistic regression, with standard covariate adjustment. RESULTS: Increased ICU delirium was independently linked to a higher TyG index (OR = 1.25, 95% CI: 1.01-1.56). RCS revealed a U-shaped relationship. The association remained stable after PSM and across multiple subgroups. SHAP analysis confirmed TyG as a meaningful predictor. CONCLUSION: A greater TyG index was linked in this retrospective analysis to a higher incidence of postoperative delirium in individuals after gastric surgery. These findings support preoperative risk stratification and targeted monitoring to enhance peri-operative safety and recovery in gastric surgery patients, and prospective studies are warranted to validate its clinical utility.