Immunonutrition and Neuromonitoring for Postoperative Delirium in Gynecologic Oncology

Early postoperative delirium (POD) is a common and distressing neuropsychiatric complication frequently observed in elderly patients undergoing major surgical interventions, including radical and cytoreductive gynecologic oncological procedures (such as ovarian, cervical, and endometrial cancer surgeries). Delirium is associated with prolonged hospital and intensive care unit stays, functional decline, elevated healthcare expenditures, and increased perioperative morbidity. The pathogenesis of postoperative delirium is multifactorial, involving baseline patient vulnerability and intraoperative triggering factors. Malnutrition and systemic inflammation are recognized as critical predisposing factors that disrupt blood-brain barrier integrity and trigger neuroinflammatory cascades. The Controlling Nutritional Status (CONUT) score and the Naples Prognostic Score (NPS) are objective scoring systems combining nutritional biomarkers (serum albumin, total cholesterol) and immune-inflammatory markers (absolute lymphocyte count, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio). Concurrently, intraoperative neuromonitoring (such as processed electroencephalography / bispectral index monitoring) provides continuous assessment of cerebral anesthetic depth and electrophysiological patterns like burst suppression, which have been implicated in acute cerebral dysfunction. The objective of this prospective observational study is to evaluate the individual and combined predictive utility of preoperative immunonutritional indices (CONUT and Naples Prognostic Score) alongside intraoperative neuromonitoring parameters for the occurrence of early postoperative delirium in elderly patients undergoing elective gynecologic oncological surgery.