Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches

Shin, Yooleemi; Kim, Duk Kyung; Jeong, Heejoon

doi:10.4097/kjae.2015.68.4.379

Cited by 28 publications

(19 citation statements)

References 22 publications

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“…Severity of surgery was identified as an independent risk factor for POD [26]. It was sought whether minimally invasive surgery reduces POD, but no impact of the surgical approach (laparascopic versus open gastrectomy) on POD incidence was found in a prospective trial [84]. In emergency hip fracture patients, delirium was already present in 57.6% of patients before surgery.…”

Section: Surgerymentioning

confidence: 99%

Patients prone for postoperative delirium

Guenther

Riedel

Radtke

2016

Current Opinion in Anaesthesiology

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An increase of the proportion of elderly patients undergoing surgery will lead to a higher incidence of POD. Preoperative assessment should facilitate identification of patients at high risk. Perioperative management should include monitoring depth of anesthesia, preference for nonopioid pain therapy, early regular delirium monitoring starting in the recovery room, avoiding ICU-sedation, early mobilization and exercise, and cognitive training.

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Section: Surgerymentioning

confidence: 99%

Patients prone for postoperative delirium

Guenther

Riedel

Radtke

2016

Current Opinion in Anaesthesiology

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“…Its incidence varies from 9% to 41%, depending on the type of surgery or timing of POD assessment [ 2 , 3 ]. In Korea, Shin et al [ 4 ] reported a POD incidence of 36.5% among elderly (> 65 years old) patients undergoing gastrectomy. Other researchers reported POD incidences of 21.4% among elderly (> 70 years old) patients undergoing neurosurgical surgeries [ 5 ], 22.7% among elderly (> 65 years old) patients undergoing cardiac surgery, and 6.7% among elderly (> 60 years old) patients undergoing orthopedic surgery [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for postoperative delirium in elderly patients after spinal fusion surgery

et al. 2020

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Background: Postoperative delirium (POD) has an incidence rate of 9% to 41%. It is directly linked to decreasing cognitive function, increasing length of hospitalization and cost, as well as other complications and mortality. We aimed to assess the risk factors for POD among elderly patients by analyzing data from those who underwent spinal surgery.Methods: This study included 446 patients aged 65 years or older who underwent spinal surgery at our institution between March 2013 and May 2018. Data were collected retrospectively from the patients’ electronic medical records, and logistic regression was used to identify the risk factors associated with POD. The diagnosis of POD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and was made through consultation with a psychiatrist during postoperative hospitalization and before discharge.Results: Seventy-eight (78/446, 17.4%) patients were diagnosed with POD. The most relevant risk factor for POD was preoperative cognitive dysfunction (odds ratio [OR], 4.37; 95% confidence interval [CI], 1.60 to 11.93; P = 0.004), followed by emergency surgery (OR, 2.70; 95% CI, 1.27 to 5.74; P = 0.01), age (OR, 1.19; 95% CI, 1.13 to 1.26; P < 0.001), and anesthesia time (OR, 1.01; 95% CI 1.00 to 1.01; P = 0.002).Conclusions: Preoperative cognitive dysfunction, emergency surgery, age, and anesthesia time were factors that affected POD occurrence after spinal surgery. Patients with such associated factors may be at a higher risk for POD when undergoing spinal surgery, and hence, careful management may be necessary for these patients.

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“…The surgical types for the patients included laparotomy operation and endoscopic surgery, which were decided to be performed by the primary diseases and the physical condition of the patients. We reviewed some studies and found that there was no difference in the incidence of POD between the two surgical types ( 26 , 27 ). Therefore, the surgical types could not be regarded as a confounding factor in our study.…”

Section: Resultsmentioning

confidence: 99%

Preoperative Status of Gut Microbiota Predicts Postoperative Delirium in Patients With Gastric Cancer

Liu

Gao

et al. 2022

Front. Psychiatry

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IntroductionPost-operative delirium (POD) is a serious complication which occurs after surgery, especially in the elderly undergoing abdominal surgery. Increasing evidence has revealed an association between the gut microbiota and psychological disorders involving the “brain-gut” axis. However, the association between the pathogenesis of POD after abdominal surgery in aging and composition of the gut microbiota remains unclear.MethodsForty patients (≥65 years old) who underwent abdominal surgery were included in the study. Twenty patients had POD, whereas 20 patients did not. POD was diagnosed and assessed using the confusion assessment method (CAM) during the postoperative period. Total DNA fractions were extracted from all fecal samples of patients. 16S rRNA sequencing was performed to determine the composition of the gut microbiota. The quality of the samples was determined by calculating the α- and β-diversities.ResultsThe α- and β-diversities indicated that the samples were eligible for detection and comparison. We observed multiple differentially abundant bacteria in patients with and without POD. Generally, Proteobacteria, Enterbacteriaceae, Escherichia shigella, Klebsiella, Ruminococcus, Roseburia, Blautia, Holdemanella, Anaerostipes, Burkholderiaceae, Peptococcus, Lactobacillus, and Dorea were abundant in the POD cohort, whereas Streptococcus equinus and Blautia hominis were abundant in the control cohort. The results of receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of Escherichia shigella was 0.75. Phenotype prediction showed that the gut microbiota may influence POD by altering the tolerance to oxidative stress.ConclusionThere were significant associations between the pathogenesis of POD and composition of the gut microbiota. Escherichia shigella are promising diagnostic bacterial species for predicting POD onset after abdominal surgery in elderly people.Clinical Trial Registrationhttp://www.chictr.org.cn/index.aspx, Chinese Clinical Trial Registry ChiCTR200030131.

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Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches

Cited by 28 publications

References 22 publications

Patients prone for postoperative delirium

Patients prone for postoperative delirium

Risk factors for postoperative delirium in elderly patients after spinal fusion surgery

Preoperative Status of Gut Microbiota Predicts Postoperative Delirium in Patients With Gastric Cancer

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