Objective To evaluate the incidence and risk factors of postoperative delirium in patients post permanent pacemaker implantation.Methods Patients underwent permanent pacemaker implantation in our department from September 2013 to February 2015 were included in this study.Delirium was measured by the confusion assessment method on the first three postoperative days.All the patients were divided into the postoperative delirium group and the non-delirium control group according to whether new onset delirium was diagnosed.Risk factors significantly associated with postoperative delirium detected by univariate analysis were entered into multivariable analysis to define the independent predictors of postoperative delirium.Results A total of 225 patients were enrolled in this study.The incidence of postoperative delirium was 5.3％.Patients developing postoperative delirium were older ((83 ± 5) years vs.(74 ± 11) years,P =0.002),had a significantly higher incidence of blood pressure fluctuations (58.3％ (7/12) vs.4.7％ (10/213),P＜0.001),hyponatremia (25.0％ (3/12) vs.5.2％ (11/213),P=0.030) and had higher systolic blood pressure ((157 ± 35) mmHg vs.(136 ± 22) mmHg,1 mmHg =0.133 kPa,P =0.007).However,patients developing postoperative delirium had lower preoperative average heart rate ((47 ± 18)bpm vs.(58 ± 15)bpm,P =0.007).Muhiple regression analysis showed that advanced age (OR =2.984,95 ％ CI:1.226-7.624,P =0.016) and blood pressure fluctuations (OR =27.393,95％ CI:6.735-111.417,P ＜0.001) are the independent risk factors for pacemaker patients with postoperative delirium.Conclusion Advanced age and blood pressure fluctuations are independent risk factors of postoperative delirium in patients post permanent pacemaker implantation.