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Lower risk of postoperative delirium using laparoscopic approach for major abdominal surgery

  • Kyoji Ito
  • Yusuke Suka
  • Motoki Nagai
  • Keishi Kawasaki
  • Mariko Yamamoto
  • Daisuke Koike
  • Yukihiro Nomura
  • Nobutaka TanakaEmail author
  • Yoshikuni KawaguchiEmail author
Article

Abstract

Background

A laparoscopic approach is increasingly being used for major abdominal surgeries and is reportedly associated with a lower incidence of postoperative complications. However, the association of laparoscopic approach and postoperative delirium remains unclear. We aimed to retrospectively investigate risk factors for postoperative delirium after abdominal surgery particularly assessing the association between a laparoscopic approach and postoperative delirium.

Methods

We retrospectively studied 801 patients who underwent major abdominal surgery between April 2012 and December 2013. Among these, 181 (22.6%) patients underwent a laparoscopic and 620 (77.4%) patients underwent an open procedure. A Cox proportional hazard model analysis was used to identify risk factors for the development of postoperative delirium or overall survival within 180 days after surgery. Cumulative incidence of postoperative delirium was assessed using a propensity score-matching analysis.

Results

Postoperative delirium occurred in 56 patients (7.0%). A Multivariate Cox proportional hazard model analysis revealed that a laparoscopic approach reduced the risk of postoperative delirium [hazard ratio (HR) 0.30, 95% confidence interval (CI) 0.07–0.84, p = 0.019]. Postoperative delirium was associated with worse overall survival within 180 days (HR 4.91, 95% CI 1.96–12.22, p = 0.001) after adjusting for other confounders using the Cox proportional hazard model analysis. Patients who developed postoperative delirium showed worse outcomes including higher rate of morbidity except delirium (p < 0.001), longer hospitalization (p < 0.001), and post-discharge institutionalization (p < 0.001). After propensity score-matching, cumulative incidence rates of postoperative delirium were significantly lower in the laparoscopic group compared to the open group (30-day cumulative incidence rate, 1.7% vs. 7.8%, p = 0.006).

Conclusions

The risk of postoperative delirium after major abdominal surgery is reduced using laparoscopic approach. Postoperative delirium should be prevented as it precipitates adverse postoperative events.

Keywords

Postoperative delirium Major abdominal surgery Laparoscopic approach Open approach 

Abbreviations

ASA

American Society of Anesthesiologists

CI

Confidence interval

HR

Hazard ratio

ICU

Intensive care unit

SD

Standard deviation

Notes

Compliance with ethical standards

Disclosures

Drs. Kyoji Ito, Yusuke Suka, Motoki Nagai, Keishi Kawasaki, Mariko Yamamoto, Daisuke Koike, Yukihiro Nomura, Nobutaka Tanaka, Yoshikuni Kawaguchi have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2018_6483_MOESM1_ESM.docx (37 kb)
Supplementary material 1 (DOCX 37 KB)

References

  1. 1.
    Deiner S, Silverstein J (2009) Postoperative delirium and cognitive dysfunction. Br J Anaesth 103:i41–i46CrossRefGoogle Scholar
  2. 2.
    Olin K, Eriksdotter-Jönhagen M, Jansson A, Herrington M, Kristiansson M, Permert J (2005) Postoperative delirium in elderly patients after major abdominal surgery. Br J Surg 92:1559–1564CrossRefGoogle Scholar
  3. 3.
    Brouquet A, Cudennec T, Benoist S, Moulias S, Beauchet A, Penna C et al (2010) Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg 251:759–765CrossRefGoogle Scholar
  4. 4.
    Raats JW, Van Eijsden WA, Crolla RM, Steyerberg EW, van der Laan L (2015) Risk factors and outcomes for postoperative delirium after major surgery in elderly patients. PLoS ONE 10:e0136071CrossRefGoogle Scholar
  5. 5.
    Ansaloni L, Catena F, Chattat R, Fortuna D, Franceschi C, Mascitti P et al (2010) Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg 97:273–280CrossRefGoogle Scholar
  6. 6.
    Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M (2009) Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg 249:173–178CrossRefGoogle Scholar
  7. 7.
    Koebrugge B, Koek HL, Van Wensen RJ, Dautzenberg PL, Bosscha K (2009) Delirium after abdominal surgery at a surgical ward with a high standard of delirium care: incidence, risk factors and outcomes. Dig Surg 26:63–68CrossRefGoogle Scholar
  8. 8.
    Vaurio LE, Sands LP, Wang Y, Mullen EA, Leung JM (2006) Postoperative delirium: the importance of pain and pain management. Anesth Analg 102:1267–1273CrossRefGoogle Scholar
  9. 9.
    Miyagawa Y, Yokoyama Y, Fukuzawa S, Fukata S, Ando M, Kawamura T et al (2016) Risk factors for postoperative delirium in abdominal surgery: a proposal of a postoperative delirium risk score in abdominal surgery. Dig Surg 34:95–102CrossRefGoogle Scholar
  10. 10.
    Kennedy GD, Heise C, Rajamanickam V, Harms B, Foley EF (2009) Laparoscopy decreases postoperative complication rates after abdominal colectomy: results from the national surgical quality improvement program. Ann Surg 249:596–601CrossRefGoogle Scholar
  11. 11.
    Yakoub D, Athanasiou T, Tekkis P, Hanna GB (2009) Laparoscopic assisted distal gastrectomy for early gastric cancer: is it an alternative to the open approach? Surg Oncol 18:322–333CrossRefGoogle Scholar
  12. 12.
    Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL (2012) Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 255(6):1048–1059CrossRefGoogle Scholar
  13. 13.
    Fuks D, Cauchy F, Ftériche S, Nomi T, Schwarz L, Dokmak S et al (2016) Laparoscopy decreases pulmonary complications in patients undergoing major liver resection: a propensity score analysis. Ann Surg 263:353–361CrossRefGoogle Scholar
  14. 14.
    Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI (1990) Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Ann Intern Med 113:941–948CrossRefGoogle Scholar
  15. 15.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205CrossRefGoogle Scholar
  16. 16.
    Group COoSTS (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004:2050–2059Google Scholar
  17. 17.
    Moghadamyeghaneh Z, Hwang GS, Hanna MH, Phelan M, Carmichael JC, Mills S et al (2016) Risk factors for prolonged ileus following colon surgery. Surg Endosc 30:603–609CrossRefGoogle Scholar
  18. 18.
    Vather R, Josephson R, Jaung R, Robertson J, Bissett I (2015) Development of a risk stratification system for the occurrence of prolonged postoperative ileus after colorectal surgery: a prospective risk factor analysis. Surgery 157:764–773CrossRefGoogle Scholar
  19. 19.
    Shin Y-H, Kim D-K, Jeong H-J (2015) Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches. Korean J Anesthesiol 68:379–385CrossRefGoogle Scholar
  20. 20.
    Siddiqi N, House AO, Holmes JD (2006) Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing 35:350–364CrossRefGoogle Scholar
  21. 21.
    Inouye SK, Charpentier PA (1996) Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability. Jama 275:852–857CrossRefGoogle Scholar
  22. 22.
    Steiner LA (2011) Postoperative delirium. Part 1: pathophysiology and risk factors. Eur J Anaesthesiol 28:628–636CrossRefGoogle Scholar
  23. 23.
    Wu F, Hoekman K, Sietses C, von Blomberg B, Meijer S, Bonjer H et al (2004) Systemic and peritoneal angiogenic response after laparoscopic or conventional colon resection in cancer patients: a prospective, randomized trial. Dis Colon Rectum 47:1670–1674CrossRefGoogle Scholar
  24. 24.
    Buunen M, Gholghesaei M, Veldkamp R, Meijer D, Bonjer H, Bouvy N (2004) Stress response to laparoscopic surgery: a review. Surg Endosc Other Interv Tech 18:1022–1028Google Scholar
  25. 25.
    Beloosesky Y, Hendel D, Weiss A, Hershkovitz A, Grinblat J, Pirotsky A et al (2007) Cytokines and C-reactive protein production in hip-fracture-operated elderly patients. J Gerontol Ser A 62:420–426CrossRefGoogle Scholar
  26. 26.
    Plaschke K, Fichtenkamm P, Schramm C, Hauth S, Martin E, Verch M et al (2010) Early postoperative delirium after open-heart cardiac surgery is associated with decreased bispectral EEG and increased cortisol and interleukin-6. Intensive Care Med 36:2081–2089CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kyoji Ito
    • 1
    • 2
  • Yusuke Suka
    • 1
  • Motoki Nagai
    • 1
  • Keishi Kawasaki
    • 1
  • Mariko Yamamoto
    • 1
  • Daisuke Koike
    • 1
  • Yukihiro Nomura
    • 1
  • Nobutaka Tanaka
    • 1
    Email author
  • Yoshikuni Kawaguchi
    • 1
    • 2
    Email author
  1. 1.Department of SurgeryAsahi General HospitalAsahiJapan
  2. 2.Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan

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