Analysis of related factors of postoperative delirium in elderly colon cancer patients undergoing radical surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIU Chunlan , CHEN Tao , LIU Lili , DAI Xin , HUANG Dongmei

Department of general surgery, Chengdu Xindu District People’s Hospital, Chengdu 610500, P. R. China;

Corresponding?author：

LIU Chunlan, Email: sjiehs756@163.com

Keywords：

elderly; colon cancer; postoperative delirium; risk factor

DOI：

10.7507/1007-9424.202312038

Video：

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Objective To explore the relevant risk factors for postoperative delirium (POD) in elderly patients undergoing radical colon cancer surgery, and provide a basis for formulating postoperative prevention and treatment measures for POD. Methods A total of 128 elderly patients diagnosed with colon cancer and underwent radical colon cancer surgery at Xindu District People’s Hospital in Chengdu from January 2018 to December 2021 were included as the study subjects. Patients were divided into two groups according to the score of Delirium Assessment Scale (4AT Scale). The basic data, main perioperative clinical data and laboratory indicators of the two groups were collected, and univariate and logistic regression analysis were carried out to determine the potential risk factors of POD in elderly patients with colon cancer after radical operation. Results According to the results of the 4AT scale score, a total score of ≥4 points was used as the threshold for determining patient POD. Among 128 patients, there were 29 patients (22.66%) with POD and 99 patients (77.34%) without POD. ① General data comparison: There was no significant difference between the two groups in gender, body mass index, years of education, hypertension, diabetes, smoking history and drinking history (P>0.05), but there was significant difference in age, preoperative mini-mental state examination (MMSE) score and American Society of Anesthesiologists (ASA) grade (P<0.05). ② Comparison of main clinical data during the perioperative period: There was no statistically significant difference between the two groups of patients in ICU treatment, nonsteroidal anti-inflammatory drug treatment, visual analogue scale, and intraoperative hypotension (P>0.05), but there was a statistically significant difference in operative time, anesthesia time, intraoperative blood loss, and dexmedetomidine treatment (P<0.05). ③ Comparison of preoperative laboratory indicators: There was no statistically significant difference between the two groups of patients in terms of hemoglobin, serum albumin, white blood cell count, prognostic nutritional index, neutrophil/lymphocyte ratio, D-dimer, and albumin to fibrinogen ratio (P>0.05). ④ The results of logistic regression analysis showed that low preoperative MMSE score [OR=0.397, 95%CI (0.234, 0.673)], long surgical time [OR=1.159, 95%CI (1.059, 1.267) ], and long anesthesia time [OR=1.138, 95%CI (1.057, 1.226) ] were independent risk factors for the occurrence of POD in elderly colon cancer patients undergoing radical surgery. Conclusion Preoperative MMSE score, operative time, and anesthesia time are closely related to the occurrence of POD in elderly colon cancer radical surgery, worth implementing key perioperative management in clinical practice to prevent and manage POD.

Citation： LIU Chunlan, CHEN Tao, LIU Lili, DAI Xin, HUANG Dongmei. Analysis of related factors of postoperative delirium in elderly colon cancer patients undergoing radical surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(6): 733-738. doi: 10.7507/1007-9424.202312038 Copy

1.	Sung H, Ferlay J, Siegel R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Laconi E, Marongiu F, DeGregori J. Cancer as a disease of old age: changing mutational and microenvironmental landscapes. Br J Cancer, 2020, 122(7): 943-952.
3.	Filippi L, Brechbiel M W. Immunotherapy for Cancer: Something Old, Something New. Cancer Biother Radiopharm, 2023, 38(4): 209-210.
4.	Hughes CG, Boncyk CS, Culley DJ, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention. Anesth Analg, 2020, 130(6): 1572-1590.
5.	張偉麗, 宋咪, 宋杰, 等. 老年骨科大手術患者術后譫妄發生現況及影響因素分析. 華西醫學, 2023, 38(10): 1474-1479.
6.	孫小珊, 孔珉珉, 孟勇, 等. 老年脊柱手術患者術后譫妄發生情況調查及相關影響因素分析. 現代生物醫學進展, 2022, 22(13): 2559-2563.
7.	Bramley P, McArthur K, Blayney A, et al. Risk factors for postoperative delirium: An umbrella review of systematic reviews. Int J Surg, 2021, 93: 106063. doi: 10.1016/j.ijsu.2021.106063.
8.	Butz M, Meyer R, Gerriets T, et al. Increasing preoperative cognitive reserve to prevent postoperative delirium and postoperative cognitive decline in cardiac surgical patients (INCORE): Study protocol for a randomized clinical trial on cognitive training. Front Neurol, 2022, 13: 1040733. doi: 10.3389/fneur.2022.1040733.
9.	Vlisides PE, Mashour GA. The Cognitive Neuraxis: Epidurals and Postoperative Delirium. Anesthesiology, 2021, 135(2): 197-199.
10.	Tieges Z, Maclullich A, Anand A, et al. Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis. Age Ageing, 2021, 50(3): 733-743.
11.	Lee S, Gottlieb M, Mulhausen P, et al. Recognition, prevention, and treatment of delirium in emergency department: An evidence-based narrative review. Am J Emerg Med, 2020, 38(2): 349-357.
12.	Jin Z, Rahman A, Pattnaik S, et al. Postoperative delirium: the findings from a multidisciplinary survey. Psychogeriatrics, 2020, 20(4): 495-500.
13.	Mendez-Martinez C, Fernandez-Martinez MN, Garcia-Suarez M, et al. Related factors and treatment of postoperative delirium in old adult patients: An integrative review. Healthcare (Basel), 2021, 9(9): 1103. doi: 10.3390/healthcare9091103.
14.	Payne T, Coburn M, Dieleman S, et al. The impact of dexmedetomidine on postoperative delirium: should we throw out a DECADE of research?. Br J Anaesth, 2023, 130(6): e479-e481. doi: 10.1016/j.bja.2023.02.040.
15.	Li GH, Zhao L, Lu Y, et al. Development and validation of a risk score for predicting postoperative delirium after major abdominal surgery by incorporating preoperative risk factors and surgical Apgar score. J Clin Anesth, 2021, 75: 110408. doi: 10.1016/j.jclinane.2021.110408.
16.	Jung DM, Ahn HJ, Yang M, et al. Hydroxyethyl starch is associated with early postoperative delirium in patients undergoing esophagectomy. J Thorac Cardiovasc Surg, 2018, 155(3): 1333-1343.
17.	Ishibashi H, Wakejima R, Asakawa A, et al. Postoperative delirium in lung cancer anatomical resection-analysis of risk factors and prognosis. World J Surg, 2022, 46(5): 1196-1206.
18.	Ballweg T, White M, Parker M, et al. Association between plasma tau and postoperative delirium incidence and severity: a prospective observational study. Br J Anaesth, 2021, 126(2): 458-466.
19.	Heng L, Wang M, Wang M, et al. Thoracic Paravertebral Block Ameliorates Postoperative Delirium in Geriatric Patients. Thorac Cardiovasc Surg, 2022, 70(5): 439-444.
20.	Iamaroon A, Wongviriyawong T, Sura-Arunsumrit P, et al. Incidence of and risk factors for postoperative delirium in older adult patients undergoing noncardiac surgery: a prospective study. BMC Geriatr, 2020, 20(1): 40. doi: 10.1186/s12877-020-1449-8.
21.	Wichmann MA, Cruickshanks KJ, Carlsson CM, et al. NSAID use and incident cognitive impairment in a population-based cohort. Alzheimer Dis Assoc Disord, 2016, 30(2): 105-112.
22.	Migirov A, Chahar P, Maheshwari K. Postoperative delirium and neurocognitive disorders. Curr Opin Crit Care, 2021, 27(6): 686-693.
23.	Choi S, Jung I, Yoo B, et al. Risk factors for postoperative delirium in elderly patients after spinal fusion surgery. Anesth Pain Med (Seoul), 2020, 15(3): 275-282.
24.	Gao Y, Zhu X, Huang L, et al. Effects of dexmedetomidine on cerebral oxygen saturation and postoperative cognitive function in elderly patients undergoing minimally invasive coronary artery bypass surgery. Clin Hemorheol Microcirc, 2020, 74(4): 383-389.
25.	Sun Y, Feng H, Zou T, et al. Assessment of risk factors for postoperative cognitive dysfunction after coronary artery bypass surgery: a single-center retrospective cohort study. Biosci Rep, 2021, 41(2): BSR20190719. doi: 10.1042/BSR20190719.

1. Sung H, Ferlay J, Siegel R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Laconi E, Marongiu F, DeGregori J. Cancer as a disease of old age: changing mutational and microenvironmental landscapes. Br J Cancer, 2020, 122(7): 943-952.
3. Filippi L, Brechbiel M W. Immunotherapy for Cancer: Something Old, Something New. Cancer Biother Radiopharm, 2023, 38(4): 209-210.
4. Hughes CG, Boncyk CS, Culley DJ, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention. Anesth Analg, 2020, 130(6): 1572-1590.
5. 張偉麗, 宋咪, 宋杰, 等. 老年骨科大手術患者術后譫妄發生現況及影響因素分析. 華西醫學, 2023, 38(10): 1474-1479.
6. 孫小珊, 孔珉珉, 孟勇, 等. 老年脊柱手術患者術后譫妄發生情況調查及相關影響因素分析. 現代生物醫學進展, 2022, 22(13): 2559-2563.
7. Bramley P, McArthur K, Blayney A, et al. Risk factors for postoperative delirium: An umbrella review of systematic reviews. Int J Surg, 2021, 93: 106063. doi: 10.1016/j.ijsu.2021.106063.
8. Butz M, Meyer R, Gerriets T, et al. Increasing preoperative cognitive reserve to prevent postoperative delirium and postoperative cognitive decline in cardiac surgical patients (INCORE): Study protocol for a randomized clinical trial on cognitive training. Front Neurol, 2022, 13: 1040733. doi: 10.3389/fneur.2022.1040733.
9. Vlisides PE, Mashour GA. The Cognitive Neuraxis: Epidurals and Postoperative Delirium. Anesthesiology, 2021, 135(2): 197-199.
10. Tieges Z, Maclullich A, Anand A, et al. Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis. Age Ageing, 2021, 50(3): 733-743.
11. Lee S, Gottlieb M, Mulhausen P, et al. Recognition, prevention, and treatment of delirium in emergency department: An evidence-based narrative review. Am J Emerg Med, 2020, 38(2): 349-357.
12. Jin Z, Rahman A, Pattnaik S, et al. Postoperative delirium: the findings from a multidisciplinary survey. Psychogeriatrics, 2020, 20(4): 495-500.
13. Mendez-Martinez C, Fernandez-Martinez MN, Garcia-Suarez M, et al. Related factors and treatment of postoperative delirium in old adult patients: An integrative review. Healthcare (Basel), 2021, 9(9): 1103. doi: 10.3390/healthcare9091103.
14. Payne T, Coburn M, Dieleman S, et al. The impact of dexmedetomidine on postoperative delirium: should we throw out a DECADE of research?. Br J Anaesth, 2023, 130(6): e479-e481. doi: 10.1016/j.bja.2023.02.040.
15. Li GH, Zhao L, Lu Y, et al. Development and validation of a risk score for predicting postoperative delirium after major abdominal surgery by incorporating preoperative risk factors and surgical Apgar score. J Clin Anesth, 2021, 75: 110408. doi: 10.1016/j.jclinane.2021.110408.
16. Jung DM, Ahn HJ, Yang M, et al. Hydroxyethyl starch is associated with early postoperative delirium in patients undergoing esophagectomy. J Thorac Cardiovasc Surg, 2018, 155(3): 1333-1343.
17. Ishibashi H, Wakejima R, Asakawa A, et al. Postoperative delirium in lung cancer anatomical resection-analysis of risk factors and prognosis. World J Surg, 2022, 46(5): 1196-1206.
18. Ballweg T, White M, Parker M, et al. Association between plasma tau and postoperative delirium incidence and severity: a prospective observational study. Br J Anaesth, 2021, 126(2): 458-466.
19. Heng L, Wang M, Wang M, et al. Thoracic Paravertebral Block Ameliorates Postoperative Delirium in Geriatric Patients. Thorac Cardiovasc Surg, 2022, 70(5): 439-444.
20. Iamaroon A, Wongviriyawong T, Sura-Arunsumrit P, et al. Incidence of and risk factors for postoperative delirium in older adult patients undergoing noncardiac surgery: a prospective study. BMC Geriatr, 2020, 20(1): 40. doi: 10.1186/s12877-020-1449-8.
21. Wichmann MA, Cruickshanks KJ, Carlsson CM, et al. NSAID use and incident cognitive impairment in a population-based cohort. Alzheimer Dis Assoc Disord, 2016, 30(2): 105-112.
22. Migirov A, Chahar P, Maheshwari K. Postoperative delirium and neurocognitive disorders. Curr Opin Crit Care, 2021, 27(6): 686-693.
23. Choi S, Jung I, Yoo B, et al. Risk factors for postoperative delirium in elderly patients after spinal fusion surgery. Anesth Pain Med (Seoul), 2020, 15(3): 275-282.
24. Gao Y, Zhu X, Huang L, et al. Effects of dexmedetomidine on cerebral oxygen saturation and postoperative cognitive function in elderly patients undergoing minimally invasive coronary artery bypass surgery. Clin Hemorheol Microcirc, 2020, 74(4): 383-389.
25. Sun Y, Feng H, Zou T, et al. Assessment of risk factors for postoperative cognitive dysfunction after coronary artery bypass surgery: a single-center retrospective cohort study. Biosci Rep, 2021, 41(2): BSR20190719. doi: 10.1042/BSR20190719.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of related factors of postoperative delirium in elderly colon cancer patients undergoing radical surgery

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