Postoperative delirium in patients with head and neck oral cancer in the West of Scotland

Crawford, James Edwin; Zubair, Farhan; Baniulyte, Gabriele; Wales, Craig; Ansell, Mark; Thomson, Ewen; Hislop, Stuart; MacIver, Colin; Devine, J.C.; McCaul, James; Young, David; McMahon, Jeremy

doi:10.1016/j.bjoms.2020.08.116

Cited by 16 publications

(9 citation statements)

References 25 publications

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“…In previous studies, many prognostic factors are examined regarding delirium in patients with OSCC. In these studies, the following factors are identified as independent predictors for the development of delirium: older age (>70 years) [11,27,30], lower intraoperative Hb levels [30], excessive bleeding during surgery with transfusions [30,31], operation time more than 7 to 10 h [24], high preoperative albumin values [25], postoperative insomnia [25], history of smoking [25], excessive alcohol consumption [12], time to ambulation after surgery [27], gender [32], postoperative pain control [32], and sedation period [26]. Excessive blood loss requiring transfusions is a commonly accepted factor that increases delirium risk, and is controlled in many study protocols.…”

Section: Discussionmentioning

confidence: 99%

“…Shiiba et al (2009) identify the male gender as a possible risk factor, and the application of intraoperative fentanyl as a protective factor. Crawford et al (2020) find that excessive alcohol consumption causes a higher risk of postoperative delirium [12]. Further parameters, such as blood pressure, albumin levels, anesthesia drugs, perioperative hypotension, and hypoxemia, were also investigated as possible factors increasing the risk of delirium, with contradictory results [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Delirium in Patients with Oral Cancer: Is Intraoperative Fluid Administration a Neglected Risk Factor?

Obermeier

Kraus

Smolka

et al. 2022

Cancers

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Squamous cell carcinoma (SCC) is a malignant tumor derived from squamous cells and can be found in different localizations. In the oral cavity especially, it represents the most common type of malignant tumor. First-line therapy for oral squamous cell carcinoma (OSCC) is surgery, including tumor resection, neck dissection, and maybe reconstruction. Although perioperative mortality is low, complications such as delirium are very common, and may have long-lasting consequences on the patient’s quality of life. This study examines if excessive fluid administration, among other parameters, is an aggravating factor for the development of postoperative delirium. A total of 198 patients were divided into groups concerning the reconstruction technique used: group A for primary wound closure or reconstruction with a local flap, and group B for microsurgical reconstruction. The patients with and without delirium in both groups were compared regarding intraoperative fluid administration, fluid balance, and other parameters, such as blood loss, duration of surgery and overall ventilation, alcohol consumption, and creatinine, albumin, natrium, and hematocrit levels. The logistic regression for group A shows that fluid intake (p = 0.02, OR = 5.27, 95% CI 1.27–21.8) and albumin levels (p = 0.036, OR = 0.22, CI 0.054–0.908) are independent predictors for the development of delirium. For group B, gender (p = 0.026, OR = 0.34, CI 0.133–0.879) with a protective effect for females, fluid intake (p = 0.003, OR = 3.975, CI 1.606–9.839), and duration of ventilation (p = 0.025, OR = 1.178, CI 1.021–1.359) are also independent predictors for delirium. An intake of more than 3000 mL for group A, and 4150 mL for group B, increases the risk of delirium by approximately five and four times, respectively. Fluid management should be considered carefully in patients with OSCC, in order to reduce the occurrence of postoperative delirium. Different factors may become significant for the development of delirium regarding different surgical procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postoperative Delirium in Patients with Oral Cancer: Is Intraoperative Fluid Administration a Neglected Risk Factor?

Obermeier

Kraus

Smolka

et al. 2022

Cancers

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“…According to the findings, the total incidence of POD in elderly people with malignant tumors was 19.6%, which was consistent with earlier reports. 7 Crawford 17 indicated that the incidence of post-surgical delirium was 7.5% among patients with head and neck oral cancer. In the adult brain tumor resection, the overall incidence was 14.78%, including 50.76% hyperactive delirium, 41.67% hypoactive delirium, and 7.57% mixed delirium.…”

Section: Discussionmentioning

confidence: 99%

Effects of Atorvastatin Therapy on Postoperative Delirium After Malignant Tumor Surgeries in Older Adults

Wu¹,

Cai²,

Pan³

et al. 2022

NDT

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Introduction Postoperative delirium (POD) is one of the prevalent and potentially fatal clinical conditions, leading to high disability and mortality in older patients, as well as increased duration of hospital stay and more hospitalization expenses. There were no effective drugs in the clinical management of POD, and an absence of evidence-based medicine concerning the treatment of POD. Materials and Methods The present study explored whether atorvastatin (Ato) can decrease the occurrence rate of POD. The present research included patients over the age of 60 who were hospitalized to critical care units (ICUs) following surgery for malignant tumors. Patients received Ato (40mg/day) or placebos utilizing a computer-based random sequencing (in a 1:1 ratio). The primary outcome measure was the occurrence of delirium within the first seven days following surgery. Results A total of 230 individuals were classified into two groups, namely the placebo group (n=123) and the Ato group (n=107). Patients belonging to two groups had similar baseline clinical data, and there were no statistically significant differences between them. The occurrence of delirium in the Ato group was remarkably reduced unlike the case in the placebo group. 30-day all-cause mortality did not vary significantly between the two groups. Pulmonary infection and Bedsore were significantly decreased in the Ato group than the placebo group, there were no statistically significant differences between the two groups in rhabdomyolysis and abnormal liver enzymes. In terms of medication responses, there were no statistically significant differences between the two groups. Ato patients had remarkably shortened hospital stays and spent remarkably less on hospitalization expenditures in comparison with those in the placebo group. Conclusion The findings from the present research indicated that Ato can decrease the occurrence of delirium following surgical operation of malignant tumors among elderly patients, it also can reduce the duration of hospitalization, hospital cost, and post-surgical complications, but not improve 30-day all-cause mortality. Registration Number ChiCTR-IPR-17011984.

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“…Table 1 summarizes the details of the process of identifying POD. 21,23,25,26,30,33,38,41 male sex, 4,37,39 smoking/tobacco use, 4,12,35 excess alcohol consumption, 12,39,41 advanced cancer stage, 8 history of neurological and psychiatric disorder, 23,30 pre-existing symptoms and comorbidities (cognitive impairment, 23,38,41 and advanced nodal disease 4 ), preoperative factors (higher ASA score 8,23 and higher albumin level 34,35,39 ), prolonged duration of surgery, 4,12,26,38,42 increased length of stay, 23 duration of ventilation, 37 the requirement of tracheostomy, 12,36 fluid imbalance, 12,25,37 longer sedation period, 27 and postoperative complications (pain 23 and insomnia 34,35 ) were reported as risk factors for the incidence of POD.…”

Section: Identifying Podmentioning

confidence: 99%

“…Four of the included studies were prospective cohort studies, and 1 was RCTs. 24 Twenty-four studies were conducted in Asia (11 in Japan, 21,22,[25][26][27]32,34,35,39,40,42 3 in China, 8,24,44 2 in South Korea, 23,30 and 1 in Taiwan 33 ), 6 in North America (all 6 in the United States 4,28,29,38,41,43 ), and 4 in Europe (3 in Germany 31,36,37 and 1 in Scotland 12 ). The sample sizes of the studies ranged from 30 to 1006 participants, the proportion of male participants ranged from 51% to 99.1%, and the mean age of the participants ranged from 54.9 to 73.7 years.…”

Section: Study Characteristicsmentioning

confidence: 99%

Incidence of Postoperative Delirium in Cancer Patients After Head and Neck Surgery: A Proportional Meta‐analysis

Ho,

Li,

Lin

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo summarize the incidence of postoperative delirium among cancer patients undergoing head and neck surgery and determine the differential incidence rates among patients undergoing different types of head and neck surgeries.Data SourcesThe databases of PubMed, Cochrane Library, Web of Science, EMBASE, and CINAHL were searched from inception till February 2023. Keywords based on the condition (delirium), context (postoperative), and population (head and neck cancer) were used as search terms.Review MethodsThe PRISMA and MOOSE reporting guidelines were followed. The Joanna Briggs Institute critical appraisal checklists for cohort studies, case‐control studies, and randomized controlled trials were used to evaluate the methodological quality. Data were pooled using a random‐effects model, and the incidence with 95% confidence intervals was evaluated using the exact binomial method and Freeman‐Tukey double arcsine transformation of proportions. I2 was used to indicate heterogeneity. Predefined subgroup analysis and Meta‐regression, was performed to identify the factors affecting heterogeneity.ResultsThe summary incidence of postoperative delirium was 18.95% [95% confidence interval, 14.36%‐24.00%] with between‐study heterogeneity (I2 = 95.46%). The incidence of postoperative delirium in patients who underwent free flap reconstruction was 22.13%, which was higher than those of other types of surgeries. Meta‐regression revealed that conducted in sample size (P = .007) of the included studies was the factors affecting heterogeneity.ConclusionsThe evidence on postoperative delirium incidence provided by the current Meta‐analysis enables effective treatment planning.

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Postoperative delirium in patients with head and neck oral cancer in the West of Scotland

Cited by 16 publications

References 25 publications

Postoperative Delirium in Patients with Oral Cancer: Is Intraoperative Fluid Administration a Neglected Risk Factor?

Postoperative Delirium in Patients with Oral Cancer: Is Intraoperative Fluid Administration a Neglected Risk Factor?

Effects of Atorvastatin Therapy on Postoperative Delirium After Malignant Tumor Surgeries in Older Adults

Incidence of Postoperative Delirium in Cancer Patients After Head and Neck Surgery: A Proportional Meta‐analysis

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