Trajectory of severity of postoperative delirium symptoms and its prospective association with cognitive function in patients with gastric cancer: results from a prospective observational study

  • Eun-Jung Shim
  • Hae Lim Noh
  • Kwang-Min Lee
  • Heesung Hwang
  • Kyung-Lak Son
  • Dooyoung Jung
  • Won-Hyoung Kim
  • Seong-Ho Kong
  • Yun-Suhk Suh
  • Hyuk-Joon Lee
  • Han-Kwang Yang
  • Bong-Jin HahmEmail author
Original Article



Delirium is a common neurocognitive complication in cancer. Despite this, the studies examining the trajectory of the severity of delirium symptoms and its impact on health outcome in gastric cancer is rather limited. This study examined the trajectory of delirium symptom severity (DSS) following resection surgery for gastric cancer and its prospective association with cognitive function.


A three-wave prospective observational study was conducted with 242 gastric cancer patients admitted for resection surgery at a teaching hospital in South Korea from May 2016 to November 2017. DSS was assessed by the clinical staff before and 1, 2, 3, and 7 days after surgery using the Delirium Rating Scale-Revised-98. A survey including the Functional Assessment of Cancer Therapy-Cognitive Scale (FACT-Cog) and Mini-Mental State Examination (MMSE) was administered before surgery (T0), 7 days after (T1), and 3 to 6 months after surgery (T2).


Out of 242 participants, 48.8% (118) completed the survey at all three time points, 43.4% (105) did so for two time points, and 7.9% (19) for one time point. No cases of full delirium were observed over four postoperative time points. Latent growth curve modeling analyses indicated that DSS declined over 3 days after surgery. Age and anesthesia time were positively associated with the initial level of DSS. A medication history for memory complaints was related to a slower recovery from delirium symptoms. While the use of propofol as an anesthetic agent was associated with lower initial DSS, it predicted a slower recovery from DSS. A higher initial DSS predicted a lower T1 MMSE score.


Severity of postoperative delirium symptoms predicts a short-term and objective cognitive function post-surgery. Monitoring and timely treatment of postoperative delirium symptoms is needed to diminish cognitive consequences in gastric cancer patients.


Anesthesia Cognitive function Delirium Gastric cancer Gastrectomy 



This study was supported by a grant of the Korean Mental Health Technology R & D Project, Ministry of Health & Welfare, Republic of Korea (HM15C1224).

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

We have full control of all primary data and we agree to allow the journal to review their data if requested.

Research involving human participants and/or animals

“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

520_2018_4604_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 21 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Eun-Jung Shim
    • 1
  • Hae Lim Noh
    • 1
  • Kwang-Min Lee
    • 2
  • Heesung Hwang
    • 3
  • Kyung-Lak Son
    • 4
  • Dooyoung Jung
    • 5
  • Won-Hyoung Kim
    • 6
  • Seong-Ho Kong
    • 7
  • Yun-Suhk Suh
    • 7
  • Hyuk-Joon Lee
    • 7
  • Han-Kwang Yang
    • 7
  • Bong-Jin Hahm
    • 3
    • 8
    Email author return OK on get
  1. 1.Department of PsychologyPusan National UniversityBusanSouth Korea
  2. 2.Public Health and Medical ServiceSeoul National University HospitalSeoulSouth Korea
  3. 3.Department of Psychiatry and Behavioral SciencesSeoul National University College of MedicineSeoulSouth Korea
  4. 4.Department of PsychiatryDongguk University Ilsan HospitalGoyangSouth Korea
  5. 5.Department of Human Factors EngineeringUlsan National Institute of Science and TechnologyUlsanSouth Korea
  6. 6.Department of PsychiatryInha University HospitalIncheonSouth Korea
  7. 7.Department of SurgerySeoul National University HospitalSeoulSouth Korea
  8. 8.Department of NeuropsychiatrySeoul National University HospitalSeoulSouth Korea

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