Risk factors analysis of delirium after head and neck reconstruction in 238 consecutive cases

doi:10.19438/j.cjoms.2020.03.007

Abstract

Abstract: PURPOSE: To observe and analyze the risk factors of postoperative delirium in patients undergoing head and neck reconstruction after tumor surgery. METHODS: From October 2018 to October 2019, 238 patients with head and neck reconstruction at the Department of Oromaxillofacial Head and Neck Oncology of Shanghai Ninth People's Hospital were included in this study. Among 238 cases, 160 were male and 78 were female. The average age was 56.52±15.31 years (rage: 16 to 85). According to postoperative results evaluated with Confusion Assessment Method (CAM), they were divided into delirium group and control group. The incidence and related risk factors of delirium were analyzed using SPSS 17.0 software package. RESULTS: The incidence of delirium after head and neck reconstruction was 10.1%(24/238). Single factor analysis results showed that delirium was associated with advanced age, hypertension, history of delirium, preoperative sleep disorder, postoperative sleep disorder, intraoperative blood transfusion and postoperative pain. Multiplelogistic regression analysis indicated that the perioperative risk factors of delirium included advanced age(OR=1.090), postoperative sleep disorder (OR=15.248), intraoperative blood transfusion (OR=1.003), and postoperative pain (OR=1.398). CONCLUSIONS: Patients with advanced age, intraoperative blood transfusion, postoperative sleep disorder and postoperative pain are the high risk groups for delirium after head and neck reconstruction. Active preventive measures should be taken to reduce the occurrence of postoperative delirium.

Key words: Postoperative delirium, Head and neck tumour, Reconstruction of defects, Risk factor

CLC Number:

R782.05

LI Xiao-dong, MENG Jian, ZHANG Ling, YE Wei-min. Risk factors analysis of delirium after head and neck reconstruction in 238 consecutive cases[J]. China Journal of Oral and Maxillofacial Surgery, 2020, 18(3): 226-230.

References

[1] Devlin JW, Skrobik Y, Gelinas C, et al.Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, Immobility, and sleep disruption in adult patients in the ICU[J]. Crit Care Med, 2018, 46(9): e825-e873.
[2] Bush SH, Tierney S, Lawlor PG.Clinical assessment and management of delirium in the palliative care setting[J]. Drugs, 2017, 77(15): 1623-1643.
[3] van Meenen LC, van Meenen DM, de Rooij SE, et al. Risk prediction models for postoperative delirium: a systematic review and meta-analysis[J]. J Am Geriatr Soc, 2014, 62(12): 2383-2390.
[4] Densky J, Eskander A, Kang S, et al.Risk factors associated with postoperative delirium in patients undergoing head and neck free flap reconstruction[J]. JAMA Otolaryngol Head Neck Surg, 2019, 145(3): 216-221.
[5] 陈佳伟, 黄燕, 徐辉, 等. 头颈部手术后谵妄危险因素的meta分析[J]. 中国口腔颌面外科杂志, 2015, 13(2): 175-181.
[6] Oh ES, Fong TG, Hshieh TT, et al.Delirium in older persons: advances in diagnosis and treatment[J]. JAMA, 2017, 318(12): 1161-1174.
[7] Zenilman ME.Delirium: an important postoperative complication[J]. JAMA, 2017, 317(1): 77-78.
[8] de Jong L, van Rijckevorsel V, Raats JW, et al. Delirium after hip hemiarthroplasty for proximal femoral fractures in elderly patients: risk factors and clinical outcomes[J]. Clin Interv Aging, 2019, 14: 427-435.
[9] Zhu Y, Wang G, Liu S, et al.Risk factors for postoperative delirium in patients undergoing major head and neck cancer surgery: a meta-analysis[J]. Jpn J Clin Oncol, 2017, 47(6): 505-511.
[10] Canet E, Amjad S, Robbins R, et al.Differential clinical characteristics, management, and outcome of delirium among ward compared with ICU patients[J]. Intern Med J, 2019, 49(12): 1496-1504.
[11] Booka E, Kamijo T, Matsumoto T, et al.Incidence and risk factors for postoperative delirium after major head and neck cancer surgery[J]. J Craniomaxillofac Surg, 2016, 44(7): 890-894.
[12] Radinovic K, Markovic-Denic L, Dubljanin-Raspopovic E, et al.Estimating the effect of incident delirium on short-term outcomes in aged hip fracture patients through propensity score analysis[J]. Geriatr Gerontol Int, 2015, 15(7): 848-855.
[13] 李呈凯, 白树财, 宋秀钢, 等. 老年髋部骨折患者术后谵妄相关危险因素的回顾性研究[J]. 中华骨科杂志, 2018, 38(4): 250-256.
[14] Aldecoa C, Bettelli G, Bilotta F, et al.European society of anaesthesiology evidence-based and consensus-based guideline on postoperative delirium[J]. Eur J Anaesthesiol, 2017, 34(4): 192-214.
[15] Otomo S, Maekawa K, Goto T, et al.Pre-existing cerebral infarcts as a risk factor for delirium after coronary artery bypass graft surgery[J]. Interact Cardiovasc Thorac Surg, 2013, 17(5): 799-804.
[16] Janssen TL, Steyerberg EW, Faes MC, et al.Risk factors for postoperative delirium after elective major abdominal surgery in elderly patients: A cohort study[J]. Int J Surg, 2019, 71(1): 29-35.
[17] Blandfort S, Gregersen M, Borris LC, et al.Blood transfusion strategy and risk of postoperative delirium in nursing homes residents with hip fracture. A post hoc analysis based on the TRIFE randomized controlled trial[J]. Aging Clin Exp Res, 2017, 29(3): 459-466.
[18] Leung JM, Sands LP, Newman S, et al.Preoperative sleep disruption and postoperative delirium[J]. J Clin Sleep Med, 2015, 11(8): 907-913.
[19] Evans JL, Nadler JW, Preud'Homme XA, et al. Pilot prospective study of post-surgery sleep and EEG predictors of post-operative delirium[J]. Clin Neurophysiol, 2017, 128(8): 1421-1425.
[20] Morin CM, Benca R.Chronic insomnia[J]. Lancet, 2012, 379(9821): 1129-1141.
[21] Vgontzas AN, Zoumakis E, Bixler EO, et al.Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines[J]. J Clin Endocrinol Metab, 2004, 89(5): 2119-2126.
[22] Wada S, Inoguchi H, Sadahiro R, et al.Preoperative anxiety as a predictor of delirium in cancer patients: A prospective observational cohort study[J]. World J Surg, 2019, 43(1): 134-142.