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Published in:

01-09-2010

Risk factors for postoperative delirium in elderly patients with colorectal cancer

Authors: Mitsuyoshi Tei, Masataka Ikeda, Naotsugu Haraguchi, Ichiro Takemasa, Tsunekazu Mizushima, Hideshi Ishii, Hirofumi Yamamoto, Mitsugu Sekimoto, Yuichiro Doki, Masaki Mori

Published in: Surgical Endoscopy | Issue 9/2010

Abstract

Aims

The aim of this retrospective study is to examine risk factors for postoperative delirium in elderly patients with colorectal cancer.

Methods

The study subjects were patients aged 71 years and older who underwent open surgery (OS) or laparoscopically assisted surgery (LAS) for colorectal cancer from January 2004 to December 2007. Preoperative evaluation, operative factors, morbidity, and mortality were analyzed using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and Prognostic Nutritional Index (PNI). Delirium was diagnosed by the Confusion Assessment Method (CAM).

Results

Postoperative delirium was diagnosed in 10.9% of elderly patients with colorectal cancer. Age, American Society of Anesthesiologists (ASA) score, and PNI were significantly higher in patients with delirium than those without (P < 0.05, each). Postoperative delirium occurred more frequently in patients with encephalopathy than in those without (P = 0.003). Logistic regression analysis identified PNI and encephalopathy as two independent risk factors for postoperative delirium.

Conclusions

Preoperative evaluation of nutritional status is important in elderly patients with colorectal cancer in order to prevent postoperative delirium.

Minagawa H, Uchitomi Y, Yamawaki S, Ishitani K (1996) Psychiatric morbidity in terminally ill cancer patients. A prospective study. Cancer 78:1131–1137CrossRefPubMed

Pereira J, Hanson J, Bruera E (1997) The frequency and clinical course of cognitive impairment in patients with terminal cancer. Cancer 79:835–842CrossRefPubMed

Lawlor PG, Gagnon B, Mancini IL, Pereira JL, Hanson J, Suarez-Almazor ME, Bruera ED (2000) Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med 160:786–794CrossRefPubMed

Marcantonio ER, Goldman L, Mangione CM, Ludwing LE, Muraca B, Haslauer CM, Donaldson MC, Whittemore AD, Sugarbaker DJ, Poss R (1994) A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 271:134–139CrossRefPubMed

Rolfson DB, McElhaney JE, Rockwood K, Finnegan BA, Entwistle LM, Wong JF, Suarez-Almazor ME (1999) Incidence and risk factors for delirium and other adverse outcomes in older adult after coronary artery bypass graft surgery. Can J Cardiol 15:771–776PubMed

Böhner H, Hummel TC, Habel U, Miller C, Reinbott S, Yang Q, Gabriel A, Friedrichs R, Müller EE, Ohmann C, Sandmann W, Schneider F (2003) Predicting delirium after vascular surgery: a model based on pre- and intraoperative data. Ann Surg 238:149–156CrossRefPubMed

Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78:356–360CrossRef

Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nippon Geka Gakkai Zasshi 85:1001–1005 (in Japanese)PubMed

Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI (1990) Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 113:941–948PubMed

10.

Blansfield JA, Clark SC, Hofmann MT, Morris JB (2004) Alimentary tract surgery in the nonagenarian: elective vs. emergent operations. J Gastrointest Surg 8:539–542CrossRefPubMed

11.

Dyer CB, Ashton CM, Teasdale TA (1995) Postoperative delirium. A review of 80 primary data-collection studies. Arch Intern Med 155:461–465CrossRefPubMed

12.

O’Brien D (2002) Acute postoperative delirium: definitions, incidence, recognition, and interventions. J Perianesth Nurs 17:384–392CrossRefPubMed

13.

Parikh SS, Chung F (1995) Postoperative delirium in the elderly. Anesth Analg 80:1223–1232CrossRefPubMed

14.

Kaneko T, Takahashi S, Naka T, Hirooka Y, Inoue Y, Kaibara N (1997) Postoperative delirium following gastrointestinal surgery in elderly patients. Surg Today 27:107–111CrossRefPubMed

15.

Aizawa K, Kanai T, Saikawa Y, Takabayashi T, Kawano Y, Miyazawa N, Yamamoto T (2002) A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery. Surg Today 32:310–314CrossRefPubMed

16.

Marcantonio ER, Goldman L, Orav EJ, Cook EF, Lee TH (1998) The association of intraoperative factors with the development of postoperative delirium. Am J Med 105:380–384CrossRefPubMed

17.

Olin K, Eriksdotter-Jönhagen M, Jansson A, Herrington MK, Kristiansson M, Permert J (2005) Postoperative delirium in elderly patients after major abdominal surgery. Br J Surg 92:1559–1564CrossRefPubMed

18.

Ganai S, Lee KF, Merrill A, Lee MH, Bellantonio S, Brennan M, Lindenauer P (2007) Adverse outcomes of geriatric patients undergoing abdominal surgery who are at high risk for delirium. Arch Surg 142:1072–1078CrossRefPubMed

Title: Risk factors for postoperative delirium in elderly patients with colorectal cancer
Authors: Mitsuyoshi Tei
Masataka Ikeda
Naotsugu Haraguchi
Ichiro Takemasa
Tsunekazu Mizushima
Hideshi Ishii
Hirofumi Yamamoto
Mitsugu Sekimoto
Yuichiro Doki
Masaki Mori
Publication date: 01-09-2010
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 9/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-010-0911-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for postoperative delirium in elderly patients with colorectal cancer

Abstract

Aims

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aims

Methods

Results

Conclusions

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