Interlaboratory comparison of a dried blood spot assay for antiretroviral adherence: implications for clinical application.

Postoperative delirium (POD) is one of the most frequent and serious complications in elderly surgical patients and is associated with prolonged hospitalization, functional decline, long-term cognitive impairment, institutionalization, and increased rates of mortality [-]. Despite advances in perioperative medicine, POD remains underrecognized and undertreated, particularly in patients undergoing non-cardiac surgeries. Laparoscopic gynecologic surgery is being increasingly performed in elderly women, who often have multiple comorbidities and age-related vulnerabilities; however, POD in this population has received less attention. Neuroinflammation is considered the central mechanism linking perioperative stress and delirium [,]. Surgical trauma, anesthetic agents, and hemodynamic instability can trigger systemic inflammatory responses that may disrupt the integrity of the blood–brain barrier, activate microglia, and alter neurotransmission. Numerous studies have investigated the biomarkers of systemic inflammation, most notably the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), as predictors of delirium and other adverse outcomes [,]. Among these, the NLR, which is derived from a routine complete blood count, is particularly attractive because it is inexpensive, widely available, and easily calculated. Recent studies have suggested that anesthetic techniques may modulate systemic inflammation [-]. Our group previously observed that remimazolam-based anesthesia attenuated postoperative inflammatory indices in comparison with volatile anesthesia in elderly gynecologic patients, but did not clearly reduce POD []. This apparent dissociation raises an important clinical question: even if modifying perioperative inflammation by anesthetic choice does not reliably prevent delirium, can inflammatory markers still serve as risk-stratification tools to facilitate prevention and monitoring?