Risk Factors for Postoperative Delirium after Liver Resection for Hepatocellular Carcinoma

Abstract

We investigated risk factors for delirium in 100 patients who underwent liver resection for hepatocellular carcinoma. Postoperative delirium developed in 17 (17%). Univariate analysis revealed that advanced age (especially = 70 years old), a history of smoking, a decreased serum albumin concentration (especially < 3.8 g/dl), advanced cancer stage (II-IV), major hepatectomy, prolonged operating time, and large intraoperative blood loss were possible risk factors for postoperative delirium. When patients' preoperative condition and laboratory test results were subjected to multivariate analysis, only advanced age [odds ratio (OR) 1.201; confidence interval (CI) 1.063-1.357] and a decreased serum albumin concentration (OR 0.151; CI 0.025-0.900) were independent risk factors for the delirium. The percentages of patients with high aspartate and alanine aminotransferase activities, a high indocyanine green retention rate at 15 minutes, a low platelet count, and advanced cancer stage (II-IV) were higher in patients with a low (< 3.8 g/dl), rather than high (= 3.8 g/dl) serum albumin concentration. These findings indicate that multiple factors, including advanced age, impaired liver function, and advanced cancer stage, affect the development of postoperative delirium after liver resection for hepatocellular carcinoma.

Cigarette Smoking as a Risk Factor for Delirium in Hospitalized and Intensive Care Unit Patients. A Systematic Review

“…Six studies restricted the smoking group to active smokers only (29,31,32,36,39,41), three studies included both active and former smokers (29,34,37,38), and five did not define the smoking group (30,33,35,40,42). The source of smoking history also varied widely between studies, ranging from self-report by patients before surgery to chart review only.…”

“…Of the eight low-to poor-quality assessment studies that either included both active and former smokers in the smoking group (37,38,40), or did not specify how cigarette smoke exposure was defined (30,(33)(34)(35)42), smoking was associated with delirium in three studies (30,35,38), and trended toward an association in one (OR, 2.78; 95% CI, 0.94-8.24; P , 0.1) (40). Only two of these studies included smoking in their multivariate analyses.…”

Postoperative Delirium After Colorectal Surgery in Older Patients

“…The validity and reliability of the CAM in postoperative patients are well established. 47,48 The instrument has a reported sensitivity of 94% (95% confidence interval, 91%-97%), a specificity of 89% (95% confidence interval, 85%-94%), surgery range from 17% 32,39 to 51%. 19 Because the number of older patients undergoing abdominal surgery, in particular, major colorectal surgery, 41 is increasing, health professionals such as nurses need to understand the potential for postoperative delirium and the associated consequences for patients.…”

“…17 However, advanced age, 8,18,19,[21][22][23][24] preexisting impaired cognition, 8,21,22,[25][26][27] use of psychotropic medications, 22,25,26,28 and impaired functional status and sensory deficits 8,21,27,29 are recognized as predisposing factors for postoperative delirium. A diverse array of precipitating factors for delirium have also been identified in surgical patients, including impaired oxygenation, 2,30 abnormal hematological and/or biochemical status, 25,26,[30][31][32] blood loss and replacement, 19,32 and intravenous infusions. 19,25,26,33 These factors also vary according to the type of surgery undertaken.…”

“…Investigation of postoperative delirium in patients undergoing abdominal surgery is important because of their multiple risk factors for this complication, including older age, high rate of malignant neoplasms, relatively long duration of surgery, 32 abnormal levels of electrolytes before surgery, 40 concurrent illnesses such as diabetes mellitus, 32,39 alcohol abuse, and functional limitations. 18,40 Not surprisingly, rates of postoperative delirium in patients who have abdominal D elirium is a common postoperative complication in older surgical patients.…”