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The assessment of risk factors for postoperative delirium using cubic spline curves in gastroenterological surgery

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Abstract

Purpose

Delirium is associated with longer hospital stays and increased medical costs and mortality. This study explored the risk factors for postoperative delirium in gastroenterological surgery and investigated the association between qualitative changes in risk factors and the incidence of postoperative delirium.

Methods

A total of 418 patients > 18 years old who underwent gastroenterological surgery at our department between April 2018 and September 2019 were included. Risk factors were identified by comparing patients with and without postoperative delirium. Continuous variables were evaluated graphically using cubic spline curves. A logistic regression analysis was performed to assess independent risk factors.

Results

The incidence of postoperative delirium was 6.9%. The cubic spline curve showed that the incidence of postoperative delirium began to increase at 50 years old and increased sharply at 70 years old. A multiple logistic regression analysis of patients > 50 years old identified 5 risk factors: age ≥ 70 years, preoperative serum albumin ≤ 3.8 g/dL, psychosis, sedative-hypnotics, and intensive-care unit admission.

Conclusion

The risk of postoperative delirium increases progressively at 50 years old and sharply at 70 years old. Advanced age, preoperative hypoalbuminemia, psychosis, sedative-hypnotics, and intensive-care unit admission are risk factors for postoperative delirium in patients > 50 years old undergoing gastroenterological surgery.

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Acknowledgements

We appreciate the advice and expertise of Dr. Isao Yokota concerning the statistical analyses.

Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan

    Yuki Okawa, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yuma Ebihara, Yo Kurashima, Toru Nakamura, Soichi Murakami, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe & Satoshi Hirano

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  1. Yuki Okawa
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  2. Kimitaka Tanaka
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  3. Yoshitsugu Nakanishi
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Correspondence to Kimitaka Tanaka.

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Supplementary Information

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595_2021_2379_MOESM1_ESM.tif

Supplementary file1 (TIF 501 KB) Fig. S1 Histograms for risk factors and cubic spline curves for risk factors and the incidence of postoperative delirium in patients over the age of 50 years. (a) Age, (b) serum albumin, (c) operation time, (d) blood loss. The x-axis of the graph represents the explanatory variable. The values on the left side of the y-axis are the predicted values of the smoothing spline. The frequency of the histogram is on the right side of the y-axis. The 95% confidence intervals are represented as dashed lines. The incidence of delirium is plotted as a circle

595_2021_2379_MOESM2_ESM.tif

Supplementary file2 (TIF 387 KB) Fig. S2 Receiver operating characteristic curves of risk factors for continuous variables in patients over the age of 50 years. (a) Age, (b) serum albumin, (c) operation time, (d) blood loss. The cut-off values are defined using the Youden Index. AUC, area under curve

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Okawa, Y., Tanaka, K., Nakanishi, Y. et al. The assessment of risk factors for postoperative delirium using cubic spline curves in gastroenterological surgery. Surg Today 51, 1969–1977 (2021). https://doi.org/10.1007/s00595-021-02379-2

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  • DOI: https://doi.org/10.1007/s00595-021-02379-2

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