Preoperative Risk Assessment for Delirium After Hepatic Resection in the Elderly: a Prospective Multicenter Study.

Autor: Ishihara A; Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan., Tanaka S; Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan. m8827074@msic.med.osaka-cu.ac.jp., Ueno M; Second Department of Surgery, Wakayama Medical University, Wakayama, Japan., Iida H; Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan., Kaibori M; Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan., Nomi T; Department of Surgery, Nara Medical University, Kashihara, Nara, Japan., Hirokawa F; Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan., Ikoma H; Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan., Nakai T; Department of Surgery, Faculty of Medicine, Kinki University, Osaka-Sayama, Osaka, Japan., Eguchi H; Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan., Shinkawa H; Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan., Hayami S; Second Department of Surgery, Wakayama Medical University, Wakayama, Japan., Maehira H; Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan., Shibata T; Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan., Kubo S; Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2021 Jan; Vol. 25 (1), pp. 134-144. Date of Electronic Publication: 2020 Mar 19.
DOI: 10.1007/s11605-020-04562-1
Abstrakt: Background: Hepatic resection often results in delirium in preoperatively self-sufficient elderly people. The association of frailty with postoperative delirium remains unclear, and preoperative risk assessment, including frailty, of postoperative delirium has not been established.
Methods: This prospective multicenter study included 295 independently living patients aged ≥ 65 years scheduled for initial hepatic resection. All patients answered the phenotypic frailty index Kihon Checklist, which is a self-reporting list of 25 questions, within a week before surgery. The risk factors for postoperative delirium were investigated. Patients who scored ≥ 4 in the Intensive Care Delirium Screening Checklist were designated as having postoperative delirium.
Results: Delirium developed after liver resection in 22 of 295 patients (7.5%). Total Kihon Checklist score (≥ 6 points), age (≥ 75 years), and serum albumin concentration (≤ 3.7 g/dL) were the independent risk factors for postoperative delirium. The proportion of patients with postoperative delirium was 0% in those with no applicable risk factors, 3.2% in those with one applicable risk factor, 12.0% in those with two applicable risk factors, and 40.9% in those with all three factors (p < 0.001). The area under the receiver operating characteristic curve for this risk assessment for predicting postoperative delirium was 0.842.
Conclusion: The use of these three factors for preoperative risk assessment may be effective in predicting and preparing for delirium after hepatic resection in elderly patients.
Databáze: MEDLINE
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