Clinical outcomes of elderly patients with colorectal cancer who had postoperative delirium and analysis of related factors / 中国医师进修杂志

ABSTRACT

Objective To compare the clinical outcomes between postoperative delirium(POD) and non- POD elderly patients with colorectal cancer and analysis of related factors. Methods Consecutive 268 elderly patients with colorectal cancer from January 2013 to March 2018 were retrospectively analyzed. These patients were evaluated daily after surgery for 7 d by confusion assessment method and were divided into delirium group and non-delirium group. Clinical outcomes were compared between the two groups, including postoperative complications, length of hospital stay, and mortality within 30 d. Logistic regression analysis was used to identify independent predictors of POD. Results Thirty-two patients (11.9% ) developed in POD, and 78.1% (25/32) POD patients were diagnosed within 3 d after surgery. Patients in delirium group had more complications [31.2%(10/32) vs. 17.4%(41/236), P＝0.031], longer postoperative hospital stay [(14.2 ± 1.6) d vs. (9.3 ± 1.8) d, P＝0.010] and higher mortality within 30 d [6.2% (2/32) vs. 1.7% (4/236), P＝0.045]. Univariate analysis revealed that advanced age, male, higher Charlson comorbidity index, higher American Society of Anesthesiologists Classification, history of psychiatric disease, history of cerebrovascular disease, alcohol abuse, lower preoperative blood albumin concentration, perioperative blood transfusion and postoperative transform to intensive care unit were significantly related to the development of POD (P＜0.05). Logistic regression analysis identified that advanced age ( OR＝1.072, 95% CI 1.012- 1.145), history of psychiatric disease ( OR＝9.806, 95% CI 2.748-25.107) and perioperative blood transfusion ( OR＝2.466, 95% CI 1.126-7.441) were independent risk factors of POD. Conclusions POD is relatively common in elderly patients undergoing colorectal cancer surgery. The high morbidity of postoperative complication and mortality is associated with POD. Comprehensively preventive strategies should be carried out for high-risk patients of advanced age, history of psychiatric disease, and perioperative blood transfusion.