Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2012

01-11-2012 | Thoracic Oncology

Incidence and Risk Factors of Postoperative Delirium in Patients with Esophageal Cancer

Authors: Mari Takeuchi, MD, Hiroya Takeuchi, MD, Daisuke Fujisawa, MD, Kaya Miyajima, MD, Kimio Yoshimura, MD, Saori Hashiguchi, MD, Soji Ozawa, MD, Nobutoshi Ando, MD, Joichiro Shirahase, MD, Yuko Kitagawa, MD, Masaru Mimura, MD

Published in: Annals of Surgical Oncology | Issue 12/2012

Login to get access

Abstract

Background

Postoperative delirium is a common complication after major surgery and is characterized by acute confusion with fluctuating consciousness. The aim of this study was to investigate the incidence and risk factors of postoperative delirium in patients with esophageal cancer.

Methods

We conducted a retrospective cohort analysis of 306 consecutive patients who had undergone an esophagectomy at Keio University Hospital from January 1998 to December 2009. All data were assessed by psychiatrists, and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual Disorder, fourth edition. Univariate and multivariate analyses were performed.

Results

Postoperative delirium developed in 153 (50.0 %) of 306 patients. One hundred fourteen (37.3 %) of the 306 patients required psychoactive medication for symptoms associated with delirium. Univariate analyses showed that older age, male gender, additional flunitrazepam for sedation in intensive care unit (ICU) after surgery, longer periods of time under mechanical ventilation after surgery, longer ICU stays, occurrence of postoperative complications, and longer hospital stays were significantly associated with postoperative delirium. Multivariate analysis revealed that development of delirium was linked to older age, additional flunitrazepam in ICU, and occurrence of postoperative complication.

Conclusions

The development of postoperative delirium in patients with esophageal cancer is a problem that cannot be ignored. Our results suggest that the risk of developing delirium is associated with older age, use of flunitrazepam in ICU, and postoperative complications.
Literature
1.
Ando N, Ozawa S, Kitagawa Y, Shinozawa Y, Kitajima M. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg. 2000;232:225–32.PubMedCrossRef
2.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edition. Washington, DC: American Psychiatric Association; 1994.
3.
Lipowski ZJ. Transient cognitive disorders (delirium, acute confusional states) in the elderly. Am J Psychiatry. 1983;140:1426–36.PubMed
4.
Edlund A, Lundström M, Lundstom G, Hedquvist B, Gustafson Y. Clinical profile of delirium in patients treated for femoral neck fractures. Dement Geriatr Cogn Disord. 1999;10:325–9.PubMedCrossRef
5.
Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA. 1990;263:1097–101.PubMedCrossRef
6.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwiz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1991;113:941–8.
7.
Marcantonio ER, Goldman L, Mangione CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994;271:134–9.PubMedCrossRef
8.
Hammeke TA, Hastings JE. Neuropsychologic alterations after cardiac operation. J Thorac Cardiovasc Surg. 1988;96:326–31.PubMed
9.
Smith LW, Dimsdale JE. Postcardiotomy delirium: conclusions after 25 years? Am J Psychiatry. 1989;146:452–8.PubMed
10.
Dyer CB, Ashton CM, Teasdale TA. Postoperative delirium. A review of 80 primary data-collection studies. Arch Intern Med. 1995;155:461–5.PubMedCrossRef
11.
Rudolph JL, Babikian VL, Birjiniuk V, et al. Atherosclerosis is associated with delirium after coronary artery bypass graft surgery. J Am Geriatr Soc. 2005;53:462–6.PubMedCrossRef
12.
Parikh SS, Chung F. Postoperative delirium in the elderly. Anesth Analg. 1995;80:1223–2.PubMed
13.
Bucerious J, Gummert JF, Borger MA, et al. Predictors of delirium after cardiac surgery delirium: effect of beating-heart (off-pump) surgery. J Thorac Cardiovasc Surg. 2004;127:57–64.CrossRef
14.
Rothenhäusler HB, Grieser B, Nollert G, Reichart B, Schelling G, Kapfhammer HP. Psychiatric and psychosocial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow-up study. Gen Hosp Psychiatry. 2005;27:18–28.PubMedCrossRef
15.
Low DE, Kunz S, Schmbre D, et al. Esophagectomy—it’s not just about mortality anymore: standardized perioperative clinical pathways improve outcome in patients with esophageal cancer. J Gastrointest Surg. 2007;11:1395–402.PubMedCrossRef
16.
Isohata N, Naritaka Y, Shimakawa T, et al. Esophageal cancer surgery in elderly patients 80 years of age or older. Ann Cancer Res Ther. 2010;18:50–3.CrossRef
17.
Chang YL, Tsai YF, Lin PJ, Chen MC, Liu CY. Prevalence and risk factors for postoperative delirium in a cardiovascular intensive care unit. Am J Crit Care. 2008;17:567–75.PubMed
18.
Brouquet A, Cudennec T, Benoist S, et al. Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg. 2010;251:759–65.PubMedCrossRef
19.
Tei M, Ikeda M, Haragush N, et al. Risk factors for postoperative delirium in elderly patients with colorectal cancer. Surg Endosc. 2010;24:2135–9.PubMedCrossRef
20.
Lee KH, Ha YC, Lee YK, Kang H, Koo KH. Frequency, risk factors, and prognosis of prolonged delirium in elderly patients after hip fracture surgery. Clin Orthop Relat Res. 2011;469:2612–20.PubMedCrossRef
21.
Colapinto ND. Is age alone a contraindication to major cancer surgery? Can J Surg. 1985;28:323–6.PubMed
22.
Barlow AP, Zarifa Z, Shillito RG, Crumpin MK, Edwards E, McCarthy JM. Surgery in a geriatric population. Ann R Coll Surg Engl. 1989;71:110–4.PubMed
23.
Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009;301:489–99.PubMedCrossRef
24.
Maldonado JR, Wysong A, van der Starre PJ, Block T, Miller C, Reitz BA. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics. 2009;50:206–17.PubMedCrossRef
25.
Lonergan E, Britton AM, Luxenberg J, Wyller T. Antipsychotics for delirium. Cochrane Database Syst Rev. 2007;CD005594.
26.
Saeki H, Ishimura H, Higashi H, et al. Postoperative management using intensive patient-controlled epidural analgesia and early rehabilitation after an esophagectomy. Surg Today. 2009;39:476–80.PubMedCrossRef
27.
Larsen KA, Kelly SE, Stern TA, et al. Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics. 2010;51:409–18.PubMed
28.
Schrader SL, Wellik KE, Demaerschalk BM, Caselli RJ, Woodruff BK, Wingerchuk DM. Adjunctive haloperidol prophylaxis reduced postoperative delirium severity and duration in at-risk elderly patients. Neurologist. 2008;14:134–7.PubMedCrossRef
29.
Ono H, Taguchi T, Kido Y, Fujino Y, Doki Y. The usefulness of bright light therapy for patients after oesophagectomy. Intens Crit Care Nurs. 2011;27:158–66.CrossRef
Metadata
Title
Incidence and Risk Factors of Postoperative Delirium in Patients with Esophageal Cancer
Authors
Mari Takeuchi, MD
Hiroya Takeuchi, MD
Daisuke Fujisawa, MD
Kaya Miyajima, MD
Kimio Yoshimura, MD
Saori Hashiguchi, MD
Soji Ozawa, MD
Nobutoshi Ando, MD
Joichiro Shirahase, MD
Yuko Kitagawa, MD
Masaru Mimura, MD
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 12/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2432-1

Other articles of this Issue 12/2012

Annals of Surgical Oncology 12/2012 Go to the issue

Melanomas

Evaluation of Incomplete Sentinel Node Biopsy Procedures and Sentinel Node Positivity Rates as Surgical Quality-Assurance Parameters in Melanoma Patients

Gastrointestinal Oncology

Postoperative Bleeding Complications after Gastric Cancer Surgery in Patients Receiving Anticoagulation and/or Antiplatelet Agents

Melanomas

The Unique Clinical Characteristics of Melanoma Diagnosed in Children

Translational Research and Biomarkers

Elevated Levels of Proliferating and Recently Migrated Tumor-associated Macrophages Confer Increased Aggressiveness and Worse Outcomes in Breast Cancer

Head and Neck Oncology

Use of Panitumumab-IRDye800 to Image Microscopic Head and Neck Cancer in an Orthotopic Surgical Model

Melanomas

A Phase I Multi-Institutional Study of Systemic Sorafenib in Conjunction with Regional Melphalan for In-Transit Melanoma of the Extremity