A clinical risk analysis of early post-operative delirium after laparoscopic colorectal cancer surgery in elderly patients: a retrospective study

• Published in: International journal of colorectal disease Vol. 36; no. 7; pp. 1461 - 1468
• Main Authors: Hiraki, Masatsugu, Tanaka, Toshiya, Ishii, Hironobu, Sadashima, Eiji, Miura, Daisuke, Sunami, Takashi, Hanafusa, Kiyoji, Sato, Hirofumi, Kitahara, Kenji
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2021; Springer; Springer Nature B.V
• Subjects: Aged patients; Analgesia; Cancer; Cancer patients; Cerebrovascular disease; Cerebrovascular diseases; Colorectal cancer; Colorectal carcinoma; Colorectal surgery; Delirium; Dementia; Dementia disorders; Droperidol; Gastroenterology; Hepatology; Internal Medicine; Laparoscopic surgery; Laparoscopy; Medicine; Medicine & Public Health; Oncology, Experimental; Original Article; Pain perception; Patients; Proctology; Risk assessment; Risk factors; Surgery; Laparoscopic surgery; Elderly patient; Post-operative delirium; Colorectal cancer
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-021-03919-5

Purpose
Early post-operative delirium (EPOD) is a frequent complication following colorectal surgery. The present study investigated the risk factors for EPOD after laparoscopic colorectal surgery in elderly patients.
Methods
A retrospective study was conducted among 208 patients ≥70 years old who underwent laparoscopic colorectal surgery. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with the EPOD.
Results
The overall incidence of EPOD was 10.1% (21/208). The univariate analysis showed that an older age (≥80 years old;
P
=0.002), sleeping pill medication before surgery (
P
=0.037), a history of dementia (
P
=0.030) and cerebrovascular disease (
P
=0.017), elevated levels of D-dimer (
P
=0.016), maximum intraoperative temperature ≥37 °C (
P
=0.036), and non-continuous usage of droperidol with analgesia (
P
=0.005) were associated with EPOD. The multivariate logistic regression analysis revealed an older age (≥80 years old; odds ratio [OR]: 6.26, 95% confidence interval [CI]: 1.94–20.15,
P
=0.002), sleeping pill medication before surgery (OR: 5.39, 95% CI: 1.36–21.28,
P
=0.016), history of cerebrovascular disease (OR: 3.91, 95% CI: 1.12–13.66,
P
=0.033), and maximum intraoperative temperature ≥37 °C (OR: 5.10, 95% CI: 1.53–16.92,
P
=0.008) to be independent risk factors. When the patients were divided into groups according to the number of positive risk factors, the prevalence rate was 6.5%, 16.0%, and 63.6% for patients with 1, 2, and 3 positive risk factors, respectively.
Conclusion
Our findings suggest that an older age, sleeping pill medication before surgery, history of cerebrovascular disease, and maximum intraoperative temperature ≥37 °C are independent risk factors of EPOD after laparoscopic colorectal surgery in elderly patients.