Low Hemoglobin Level Is Associated with the Development of Delirium after Hepatectomy for Hepatocellular Carcinoma Patients

Abstract

BackgroundHepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide and liver resection is the only potential curative treatment option for those patients. Postoperative complications specific to elderly surgical patients such as delirium will be increasingly relevant in the coming decades. Herein, we aimed to investigate the risk factors for postoperative delirium in patients who have received hepatectomy for HCC.MethodsThis is a single medical center observational study and the study subjects comprised 401 individuals who underwent liver resection for hepatocellular carcinoma during January 2009 to October 2013. Multivariate analysis was used to examine whether preoperative, intra-operative, or postoperative variables were associated with the development of delirium.ResultsOf the 401 patients who underwent hepatectomy, 34 developed postoperative delirium (8.4%). In the majority of those patients, symptoms and signs of the syndrome occurred on postoperative day 2 and the mean duration of symptoms was 3.61 ± 3.71 days. Multivariate analysis revealed that advanced age (>71 years) [odds ratio (OR) = 1.133, 95% confidence interval (CI): 1.071–1.200, p<0.001], prolonged operative time (>190 minutes) (OR = 1.009, 95% CI: 1.000–1.017, p = 0.038), a decreased postoperative hemoglobin level (< 10.16 g/dL) (OR = 0.777, 95% CI: 0.613–0.983, p = 0.036), and history of hypnotic drug use (OR = 3.074, 95% CI: 1.045–9.039, p = 0.041) were independent risk factors for the development of postoperative delirium after hepatectomy.ConclusionsAlthough the mechanism of postoperative delirium is not well understood, numbers of studies have shown that patients with postoperative delirium tend to have prolonged hospital stay, worse postoperative outcome and an increased risk of short- and long-term mortality. In this study, we found that advanced age, prolonged operative time, postoperative low hemoglobin level and history of hypnotic drug use are independent risk factors for postoperative delirium.

Prevalence and risk factors of postoperative delirium in elderly hip fracture patients

“…anaesthetics) are metabolized in the liver, liver function is closely related to neurological status. 6 This present study showed that elderly patients with preoperative decreased albumin and increased total bilirubin were at a heightened risk of experiencing PD.…”

“… 5 Elderly patients with a history of hypnotic drug use, preoperative dementia, anxiety and depression are more prone to PD compared with other elderly patients. 6 , 7…”

Does an extreme age (≥80 years) affect outcomes in patients after liver cancer surgery? A meta‐analysis

“…Post‐operative delirium occurred at a high rate of 33.1% among super‐elderly patients in the current meta‐analysis, which was also higher than the reported rates ranging from 8.4 to 22% among patients of a younger age, ranging from 65 to 71 years, after liver resection . It was reported that an advanced age, low serum albumin level and a high probability of preoperative cerebrovascular disorders were independent risk factors for post‐operative delirium in patients after liver resection, while these features were also observed in the current meta‐analysis (Table ). Perioperative intervention, including psychiatric consultation, albumin level tests and perioperative risk evaluation and monitoring, should be strongly considered for the prevention and early treatment of post‐operative delirium …”

Patients prone for postoperative delirium

“…Low postoperative hemoglobin was associated with the development of delirium after hepatectomy [56]. Length of red-cell unit storage of less than 14 days was not associated with increased rate of delirium in cardiac surgery [57], but a storage time of more than 14 days was associated not only with significantly increased inflammatory plasma parameters such as interleukin-8 and interleukin-1ß, but also with increased length (but not incidence) of POD in elderly patients undergoing hip fracture surgery [58].…”