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International Urology and Nephrology

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13-12-2023 | Urological Surgery | Urology - Original Paper

Mesial temporal atrophy in preoperative MRI rather than steep Trendelenburg position is associated with postoperative delirium in patients undergoing a major urologic surgery

Authors: Jae Hyon Park, Insun Park, Jongjin Yoon, Yongsik Sim, Jinhyun Kim, Seung-Koo Lee, Bio Joo

Published in: International Urology and Nephrology | Issue 5/2024

Abstract

Purpose

To investigate whether steep Trendelenburg in a major urologic surgery is associated with postoperative delirium, and to examine other potential clinical and radiologic factors predictive of postoperative delirium.

Methods

182 patients who received a major urologic surgery and underwent a 3.0-T brain MRI scan within 1 year prior to the date of surgery were retrospectively enrolled. Preoperative brain MRIs were used to analyze features related to small vessel disease burden and mesial temporal atrophy. Presence of a significant mesial temporal atrophy was defined as Scheltens’ scale ≥ 2. Patients’ clinico-demographic data and MRI features were used to identify significant predictors of postoperative delirium using the logistic regression analysis. Independent predictors found significant in the univariate analysis were further evaluated in the multivariate analysis.

Results

Incidence of postoperative delirium was 6.0%. Patients with postoperative delirium had lower body mass index (21.3 vs. 25.0 kg/m², P = 0.003), prolonged duration of anesthesia (362.7 vs. 224.7 min, P < 0.001) and surgery (302.2 vs. 174.5 min, P < 0.001), and had more significant mesial temporal atrophy (64% vs. 30%, P = 0.046). In the univariate analysis, female sex, type of surgery (radical prostatectomy over cystectomy), prolonged duration of anesthesia (≥ 6 h), and presence of a significant mesial temporal atrophy were significant predictors (all P-values < 0.050), but only the presence of significant mesial temporal atrophy was significant in the multivariate analysis [odds ratio (OR), 3.69; 95% CI 0.99–13.75; P = 0.046].

Conclusion

Steep Trendelenburg was not associated with postoperative delirium. Significant mesial temporal atrophy (Scheltens’ scale ≥ 2) in preoperative brain MRI was predictive of postoperative delirium.

Trial registration

Not applicable.

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Title: Mesial temporal atrophy in preoperative MRI rather than steep Trendelenburg position is associated with postoperative delirium in patients undergoing a major urologic surgery
Authors: Jae Hyon Park
Insun Park
Jongjin Yoon
Yongsik Sim
Jinhyun Kim
Seung-Koo Lee
Bio Joo
Publication date: 13-12-2023
Publisher: Springer Netherlands
Keywords: Urological Surgery
Urological Surgery
Prostatectomy
Prostatectomy
Cranial MRI
Cystectomy
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Published in: International Urology and Nephrology / Issue 5/2024
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-023-03898-2

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