Skip to main content

Predictive Factors of Postoperative Delirium in Patients After Pancreaticoduodenectomy

Journal of Gastrointestinal Surgery volume 24, pages 849–854 (2020)Cite this article

Abstract

Background

Postoperative delirium is a common serious complication after various types of surgery. However, the incidence and predictive factors associated with delirium after pancreaticoduodenectomy (PD) have not been investigated. Thus, this study aimed to investigate the incidence and predictive factors of postoperative delirium in patients who underwent PD.

Methods

This study included 155 consecutive patients who underwent PD. Patients with and without postoperative delirium were compared to identify differential patient characteristics. Multivariate regression analysis was used to statistically identify independent predictive factors significantly associated with the development of postoperative delirium.

Results

Postoperative delirium developed in 27 (22.4%) of 155 patients. The majority of incidents occurred on postoperative day 2, and the mean delirium duration was 4.6 ± 4.8 days. Patients with postoperative delirium had an older age and a previous history of benzodiazepine use. A multivariate analysis revealed that the development of delirium was significantly correlated with these two factors. Receiver-operator characteristics (ROC) curve analysis of the two factors yielded an area under the ROC curve of 0.823 (0.750–0.896), suggesting good discrimination power.

Conclusions

This study reports on the incidence of postoperative delirium after PD. Furthermore, we identified age and use of benzodiazepines as significant predictive factors for developing delirium after PD. These results contribute to the prediction and treatment of postoperative delirium.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22. https://doi.org/10.1016/S0140-6736(13)60688-1.

    Article  Google Scholar 

  2. Marcantonio ER, Juarez G, Goldman L, Mangione CM, Ludwig LE, Lind L et al. The relationship of postoperative delirium with psychoactive medications. Jama. 1994;272(19):1518–22.

    CAS  Article  Google Scholar 

  3. Ogawa M, Izawa KP, Satomi-Kobayashi S, Kitamura A, Tsuboi Y, Komaki K et al. Preoperative exercise capacity is associated with the prevalence of postoperative delirium in elective cardiac surgery. Aging clinical and experimental research. 2018;30(1):27–34. https://doi.org/10.1007/s40520-017-0736-5.

    Article  PubMed  Google Scholar 

  4. Park SA, Tomimaru Y, Shibata A, Miyagawa S, Noguchi K, Dono K. Incidence and Risk Factors for Postoperative Delirium in Patients After Hepatectomy. World journal of surgery. 2017;41(11):2847–53. https://doi.org/10.1007/s00268-017-4079-3.

    Article  PubMed  Google Scholar 

  5. Takeuchi M, Takeuchi H, Fujisawa D, Miyajima K, Yoshimura K, Hashiguchi S et al. Incidence and risk factors of postoperative delirium in patients with esophageal cancer. Annals of surgical oncology. 2012;19(12):3963–70. https://doi.org/10.1245/s10434-012-2432-1.

    Article  PubMed  Google Scholar 

  6. Tei M, Wakasugi M, Kishi K, Tanemura M, Akamatsu H. Incidence and risk factors of postoperative delirium in elderly patients who underwent laparoscopic surgery for colorectal cancer. International journal of colorectal disease. 2016;31(1):67–73. https://doi.org/10.1007/s00384-015-2335-2.

    Article  PubMed  Google Scholar 

  7. Association AP. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013.

    Book  Google Scholar 

  8. Galanakis P, Bickel H, Gradinger R, Von Gumppenberg S, Forstl H. Acute confusional state in the elderly following hip surgery: incidence, risk factors and complications. International journal of geriatric psychiatry. 2001;16(4):349–55.

    CAS  Article  Google Scholar 

  9. Aldemir M, Ozen S, Kara IH, Sir A, Bac B. Predisposing factors for delirium in the surgical intensive care unit. Crit Care. 2001;5(5):265–70.

    CAS  Article  Google Scholar 

  10. Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. Jama. 1990;263(8):1097–101.

    CAS  Article  Google Scholar 

  11. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of internal medicine. 1990;113(12):941–8.

    CAS  Article  Google Scholar 

  12. Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM et al. A clinical prediction rule for delirium after elective noncardiac surgery. Jama. 1994;271(2):134–9.

    CAS  Article  Google Scholar 

  13. Rudolph JL, Babikian VL, Birjiniuk V, Crittenden MD, Treanor PR, Pochay VE et al. Atherosclerosis is associated with delirium after coronary artery bypass graft surgery. Journal of the American Geriatrics Society. 2005;53(3):462–6. https://doi.org/10.1111/j.1532-5415.2005.53165.x.

    Article  PubMed  Google Scholar 

  14. Gallagher TK, McErlean S, O'Farrell A, Hoti E, Maguire D, Traynor OJ et al. Incidence and risk factors of delirium in patients post pancreaticoduodenectomy. HPB: the official journal of the International Hepato Pancreato Biliary Association. 2014;16(9):864–9. https://doi.org/10.1111/hpb.12266.

    Article  Google Scholar 

  15. Ito Y, Abe Y, Handa K, Shibutani S, Egawa T, Nagashima A et al. Postoperative Delirium in Patients after Pancreaticoduodenectomy. Digestive surgery. 2017;34(1):78–85. https://doi.org/10.1159/000446928.

    Article  PubMed  Google Scholar 

  16. Mizuno S, Takeuchi S, Kishiwada M, Mizutani N, Matsuda M, Sekoguchi N et al. Incidence and Risk Factors of Postoperative Delirium following Pancreatic Surgery: Does the Administration of TJ-54 Reduce the Incidence of Delirium. Digestive surgery. 2018;35(1):1–10. https://doi.org/10.1159/000456627.

    Article  PubMed  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery. 2004;240(2):205–13.

    Article  Google Scholar 

  18. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36.

    CAS  Article  Google Scholar 

  19. Harrell FE, Jr., Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15(4):361–87. https://doi.org/10.1002/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4.

    Article  PubMed  Google Scholar 

  20. Dyer CB, Ashton CM, Teasdale TA. Postoperative delirium. A review of 80 primary data-collection studies. Archives of internal medicine. 1995;155(5):461–5.

    CAS  Article  Google Scholar 

  21. Hammeke TA, Hastings JE. Neuropsychologic alterations after cardiac operation. The Journal of thoracic and cardiovascular surgery. 1988;96(2):326–31.

    CAS  Article  Google Scholar 

  22. Smith LW, Dimsdale JE. Postcardiotomy delirium: conclusions after 25 years? The American journal of psychiatry. 1989;146(4):452–8. https://doi.org/10.1176/ajp.146.4.452.

    CAS  Article  PubMed  Google Scholar 

  23. Jung DM, Ahn HJ, Yang M, Kim JA, Kim DK, Lee SM et al. Hydroxyethyl starch is associated with early postoperative delirium in patients undergoing esophagectomy. The Journal of thoracic and cardiovascular surgery. 2018;155(3):1333–43. https://doi.org/10.1016/j.jtcvs.2017.10.077.

    CAS  Article  PubMed  Google Scholar 

  24. Murakawa K, Kitamura Y, Watanabe S, Hongo S, Shinomiya K, Sendo T. Clinical risk factors associated with postoperative delirium and evaluation of delirium management and assessment team in lung and esophageal cancer patients. Journal of pharmaceutical health care and sciences. 2015;1:4. https://doi.org/10.1186/s40780-014-0002-3.

    Article  PubMed  PubMed Central  Google Scholar 

  25. van der Sluis FJ, Buisman PL, Meerdink M, Aan de Stegge WB, van Etten B, de Bock GH et al. Risk factors for postoperative delirium after colorectal operation. Surgery. 2017;161(3):704–11. https://doi.org/10.1016/j.surg.2016.09.010.

    Article  PubMed  Google Scholar 

  26. Chen YL, Lin HC, Lin KH, Lin LS, Hsieh CE, Ko CJ et al. Low hemoglobin level is associated with the development of delirium after hepatectomy for hepatocellular carcinoma patients. PloS one. 2015;10(3):e0119199. https://doi.org/10.1371/journal.pone.0119199.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. Yoshimura Y, Kubo S, Shirata K, Hirohashi K, Tanaka H, Shuto T et al. Risk factors for postoperative delirium after liver resection for hepatocellular carcinoma. World journal of surgery. 2004;28(10):982–6. https://doi.org/10.1007/s00268-004-7344-1.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan

    Yoshito Tomimaru, Sung Ae Park, Kozo Noguchi, Shingo Noura, Hiroshi Imamura & Keizo Dono

  2. Department of Psychiatry, Toyonaka Municipal Hospital, Toyonaka, Japan

    Asuka Shibata & Shinichi Miyagawa

  3. Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

    Toru Shirakawa

Authors
  1. Yoshito Tomimaru
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sung Ae Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Asuka Shibata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shinichi Miyagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kozo Noguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shingo Noura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroshi Imamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Toru Shirakawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Keizo Dono
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study design: Y Tomimaru and SA Park.

Acquisition of data: Y Tomimaru, SA Park, A Shibata, S Miyagawa, and K Noguchi.

Analysis and interpretation: Y Tomimaru, SA Park, A Shibata, S Miyagawa, and T Shirakawa.

Manuscript preparation: Y Tomimaru and SA Park.

Assistance with data interpretation: S Noura, H Imamura, T Iwazawa, and K Dono.

Corresponding author

Correspondence to Yoshito Tomimaru.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tomimaru, Y., Park, S.A., Shibata, A. et al. Predictive Factors of Postoperative Delirium in Patients After Pancreaticoduodenectomy. J Gastrointest Surg 24, 849–854 (2020). https://doi.org/10.1007/s11605-019-04212-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-019-04212-1

Keywords

  • Delirium
  • Postoperative delirium
  • Pancreaticoduodenectomy