A novel predictive model for postoperative delirium using multiple geriatric screening factors

Abstract

Objectives The purpose of this study was to develop a new composite score to accurately predict postoperative delirium (POD) after major urological cancer surgery. Methods Our retrospective analysis included, in total, 449 consecutive patients who experienced major urological cancer surgery and a preoperative geriatric functional assessment at our institution (development cohort). Geriatric functional assessments included Geriatric 8, Instrumental Activities of Daily Living, and mini‐cognitive assessment instrument (Mini‐Cog). Multivariate analysis was used to identify factors related to POD and combined to create a predictive score. The composite score was externally validated using a cohort of 92 consecutive pancreatic cancer patients who underwent pancreaticoduodenectomy and a preoperative geriatric functional assessment (validation cohort). The predictive accuracy and performance of the composite score were evaluated using the area under the receiver operating characteristic curves (AUC) and calibration plots. Results In multivariate analysis of a development cohort, the following factors were significantly associated with POD: a Mini‐Cog score of <3 (odds ratio [OR] = 9.5; p < 0.001), disability in the responsibility for medication (OR = 4.1; p = 0.03), and the preoperative use of benzodiazepine (OR = 6.4; p < 0.001). The composite score of these three factors showed excellent discrimination in predicting POD, with AUC values of 0.819 and 0.804 in development and validation cohorts, respectively. Calibration plots showing predicted probability and actual observation in both cohorts showed good agreement. Conclusions A combined model of Mini‐Cog, a disability in the responsibility for medication, and preoperative benzodiazepine use showed excellent discriminative power in predicting POD.

Preoperative cognitive function as a risk factor of postoperative delirium in cancer surgeries: A systematic review and meta‐analysis

“…A total of 48 articles were included in this study (Table 1), of which 39 (81.25%) studies were cohort, [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][39][40][41][42][45][46][47][49][50][51]54,57,[59][60][61][62][63][64][65][66][67][68] and 8 (16.6%) were randomized clinical 38,43,44,48,52,53,55,58 trials (one article excluded in the late stage as it was retracted in the publisher journal).…”

“…Twenty-three studies included samples comprised of patient with gastrointestinal (GI) cancers, 22,24,26,[28][29][30][31][32][33]35,36,39,40,42,49,50,53,55,57,58,60,65,67 seven with urological cancers, 25,27,[45][46][47]62,68 nine on various cancers, 34,38,43,48,51,52,56,59,64 three with head and neck cancers, 21,23,41 and one with gynecological, lung, oral, and brain (tumor) cancers, respectively. Of the 48 studies, 39 [21][22][23][24][25][26][27][28]…”

“…Of the 48 studies, 39 [21][22][23][24][25][26][27][28][29][30][31][32][33]35,36,[38][39][40]42,43,[48][49][50][51][52][53][54][55][56][57][58][59][60][61]63,[65][66][67][68] used MMSE to assess cognitive function, six 34,[44][45][46][47]64 used Mini-cog, one 37 used Montreal Cognitive Assessment (MoCA), one 62 used Hierarchic Dementia Scale-Revised (HDS-R) and one 41 used the patient's medical history as a cognitive assessment preoperatively. For POD assessment, the most used tools were CAM, 22,23,25,…”

“…In terms of the ages of samples (Table 2), all studies had a mean age >65 (most had a mean age >70), and just 15 studies 28,29,33,35,37,39,41,43,45,46,51,53,56,58,67 reported a significant impact of age on the development of POD was reflected in the multivariate analysis (OR range = 1.06-7.30). Twenty-two of the studies showed that age is significantly associated with delirium, [23][24][25]28,29,33,35,37,39,41,42,46,47,51,53,56,58,60,63,64,67,68 while only one study found no significance between age and POD, 61 and five studies did not report any comparison. 38,44,51,55,57…”

The significance of G8 and other geriatric assessments in urologic cancer management: A comprehensive review

“…The mini‐cognitive assessment instrument (Mini‐Cog), 80 a simple screening tool consisting only of a three‐word playback and clock drawing, has diagnostic capabilities similar to MMSE 81 and is recommended by the SIOG task force for use in screening 73 . The authors also reported that the patients with Mini‐Cog <3 had a higher risk of delirium after major urologic surgery 82,83 or transurethral surgery under spinal anesthesia 84 . The insertion of a urinary catheter can increase the risk of delirium, 85 as shown by in vivo experiments with mice exhibiting delirium‐like behavior after catheterization 86 .…”