World Journal of Surgery

, Volume 43, Issue 1, pp 134–142 | Cite as

Preoperative Anxiety as a Predictor of Delirium in Cancer Patients: A Prospective Observational Cohort Study

  • Saho Wada
  • Hironobu Inoguchi
  • Ryoichi Sadahiro
  • Yutaka J. Matsuoka
  • Yosuke Uchitomi
  • Tetsufumi Sato
  • Kazuaki Shimada
  • Seichi Yoshimoto
  • Hiroyuki Daiko
  • Ken ShimizuEmail author
Original Scientific Report



Postoperative delirium is a common and important complication in cancer patients. We need to identify patients at high risk of postoperative delirium such that it can be prevented preoperatively or in early postoperative phase. The aim of this study was to investigate whether preoperative anxiety predicted onset of postoperative delirium in cancer patients, not only in order to identify high-risk groups but also to help develop new preventive approaches.


This was a prospective observational cohort study of cancer patients undergoing tumor resections. Postoperative delirium was assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Preoperative anxiety was evaluated with the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), and we defined HADS-A > 7 as clinical anxiety. We conducted multivariate logistic regression to determine which factors were predictors of delirium.


The final analysis included 91 patients, 29 of whom met the criteria for postoperative delirium. In multivariable logistic regression, age (5-year increments; odds ratio (OR) = 1.565, 95% confidence interval (CI) = 1.057–2.317, p = 0.025) and HADS-A > 7 (OR = 4.370, 95% CI = 1.051–18.178, p = 0.043) predicted delirium onset. These variables explained 74.2% of the variance.


Preoperative anxiety strongly predicted postoperative delirium in cancer patients. Our findings suggest that preoperative anxiety may be a new target for prevention of postoperative delirium.

Trial registration number This study was registered at UMIN000018980



The authors express special gratitude to Yumi Kikukawa, CP and Koji Washizuka, CP for their help in conducting the study, and the physicians and nurses of the departments that cooperated with this study.


This work was supported by the National Cancer Center Research and Development Fund 26-A-29 from National Cancer Center in Japan.

Compliance with ethical standards

Conflict of interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Saho Wada
    • 1
    • 2
  • Hironobu Inoguchi
    • 1
  • Ryoichi Sadahiro
    • 1
    • 2
  • Yutaka J. Matsuoka
    • 1
    • 2
    • 3
  • Yosuke Uchitomi
    • 1
    • 2
    • 4
  • Tetsufumi Sato
    • 5
  • Kazuaki Shimada
    • 6
  • Seichi Yoshimoto
    • 7
  • Hiroyuki Daiko
    • 8
  • Ken Shimizu
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of Psycho-OncologyNational Cancer Center HospitalChuo-kuJapan
  2. 2.Division of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health SciencesNational Cancer Center JapanChuo-kuJapan
  3. 3.Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center HospitalNational Cancer Center HospitalChuo-kuJapan
  4. 4.Behavioral Sciences and Survivorship Research Group, Center for Public Health SciencesNational Cancer Center JapanChuo-kuJapan
  5. 5.Department of Anesthesia and Intensive CareNational Cancer Center HospitalChuo-kuJapan
  6. 6.Department of Hepatobiliary and Pancreatic SurgeryNational Cancer Center HospitalChuo-kuJapan
  7. 7.Department of Head and Neck OncologyNational Cancer Center HospitalChuo-kuJapan
  8. 8.Department of Esophageal SurgeryNational Cancer Center HospitalChuo-kuJapan

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