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

Abstract

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.

Monopolar electrocautery versus sharp dissection in the neck dissection: a retrospective study

“…The shorter operation time using the ME is probably due to the fact that ME immediately coagulates smaller bleedings, too. A shorter operation time may lead to decreased risk for postoperative delirium 17 and may affect the hospitalization and the patient's postoperative quality of life 18 . Hasegawa et al 19 found that older age, extensive surgical procedures, more prolonged operation, excessive bleeding, and blood transfusion may lead to more extended postoperative management in the intensive care unit, a longer hospital stay and postoperative delirium.…”

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

“…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.…”

“…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.…”

“…Two studies (7.4%) reported the use of the Confusion Assessment Method (CAM), 8,26 and 1 study (3.7%) reported the use of CAM-ICU. 24 Other delirium assessment tools, such as Intensive Care Delirium Screening Checklist (ICDSC), 36 and Nursing Delirium Screening Scale (Nu-DESC), 37 which have been validated for delirium assessment, were also applied. Table 1 summarizes the details of the process of identifying POD.…”

Single Nucleotide Polymorphism and mRNA Expression of LTF in Oral Squamous Cell Carcinoma

“…In 2020, 377,713 new cases and 177,757 deaths were reported, with high incidence rates in Eastern and Western Europe [ 1 ]. The list of risk factors associated with OSCC includes the use of tobacco, alcohol consumption or human papillomavirus (HPV) infections [ 2 ]. Unfortunately, all causes of OSCC are not well-understood [ 3 ].…”