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Dong B, Yu D, Zhang H, Li P, Li Y, Li C, Li J. Association between preoperative sarcopenia and postoperative delirium in older patients undergoing gastrointestinal cancer surgery. Front Aging Neurosci 2024; 16:1416569. [PMID: 39144259 PMCID: PMC11322050 DOI: 10.3389/fnagi.2024.1416569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/19/2024] [Indexed: 08/16/2024] Open
Abstract
Background Postoperative delirium (POD) is a usual neurological complication, often leading to poor prognoses. Early identification of high-risk patients is crucial for preventing POD. Sarcopenia is an age-related geriatric syndrome characterized by the loss of skeletal muscle mass and function, and previous studies indicated that preoperative low muscle mass might be a predictor for POD. However, the association between preoperative sarcopenia and POD remains to be fully elucidated. This study was to explore the correlation between preoperative sarcopenia and POD following gastrointestinal cancer surgery in older patients. Methods Older patients (≥60 years) undergoing gastrointestinal cancer surgery were enrolled. Sarcopenia was defined based on the Special Interest Group on sarcopenia of the International Society of Physical and Rehabilitation Medicine (ISarcoPRM), which combined the loss of muscle mass (evaluated by ultrasound) and function (assessed by chair stand test and handgrip strength) before surgery. POD assessment was performed using the Confusion Assessment Method (CAM) or CAM for the intensive care unit (CAM-ICU) during the first 7 days after surgery or before discharge. Multivariate logistic regression analysis examined the correlation between preoperative sarcopenia and POD. Moreover, the receiver operator characteristic (ROC) curve was applied to analyze the predictive effect of the preoperative sarcopenia in POD. Results One hundred and thirty patients were finally included, of which 43 patients presented with sarcopenia before surgery. Twenty-four patients ultimately developed POD, and the incidence was 18.5%. The results of the multivariate analyses demonstrated that preoperative sarcopenia was still independently associated with POD after adjusting for age ≥70 years, preoperative Mini-Mental State Examination score, and intraoperative blood transfusion. The area under the ROC curve of preoperative sarcopenia in predicting POD was 0.680 (95% confidence interval 0.557-0.804). Conclusion Preoperative sarcopenia defined by ISarcoPRM criteria was independently associated with POD in geriatric patients after gastrointestinal cancer surgery.
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Affiliation(s)
- Bo Dong
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Graduate Faculty, Hebei North University, Zhangjiakou, China
| | - Dongdong Yu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Pan Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yi Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Chong Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
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Luo YG, Wu XD, Song YX, Wang XL, Liu K, Shi CT, Wang ZL, Ma YL, Li H, Liu YH, Mi WD, Lou JS, Cao JB. Development and validation of a nomogram to predict postoperative delirium in older patients after major abdominal surgery: a retrospective case-control study. Perioper Med (Lond) 2024; 13:41. [PMID: 38755693 PMCID: PMC11100071 DOI: 10.1186/s13741-024-00399-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Postoperative delirium is a common complication in older patients, with poor long-term outcomes. This study aimed to investigate risk factors and develop a predictive model for postoperative delirium in older patients after major abdominal surgery. METHODS This study retrospectively recruited 7577 patients aged ≥ 65 years who underwent major abdominal surgery between January 2014 and December 2018 in a single hospital in Beijing, China. Patients were divided into a training cohort (n = 5303) and a validation cohort (n = 2224) for univariate and multivariate logistic regression analyses and to build a nomogram. Data were collected for 43 perioperative variables, including demographics, medical history, preoperative laboratory results, imaging, and anesthesia information. RESULTS Age, chronic obstructive pulmonary disease, white blood cell count, glucose, total protein, creatinine, emergency surgery, and anesthesia time were associated with postoperative delirium in multivariate analysis. We developed a nomogram based on the above 8 variables. The nomogram achieved areas under the curve of 0.731 and 0.735 for the training and validation cohorts, respectively. The discriminatory ability of the nomogram was further assessed by dividing the cases into three risk groups (low-risk, nomogram score < 175; medium-risk, nomogram score 175~199; high-risk, nomogram score > 199; P < 0.001). Decision curve analysis revealed that the nomogram provided a good net clinical benefit. CONCLUSIONS We developed a nomogram that could predict postoperative delirium with high accuracy and stability in older patients after major abdominal surgery.
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Affiliation(s)
- Yun-Gen Luo
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- Medical School of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
- Beidaihe Rest and Recuperation Center of People's Liberation Army, Hebei, 066100, China
| | - Xiao-Dong Wu
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yu-Xiang Song
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiao-Lin Wang
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Kai Liu
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Chun-Ting Shi
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zi-Lin Wang
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yu-Long Ma
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Hao Li
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yan-Hong Liu
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Wei-Dong Mi
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jing-Sheng Lou
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Jiang-Bei Cao
- Department of Anesthesiology, the First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
- National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Melucci AD, Loria A, Aquina CT, McDonald G, Schymura MJ, Schiralli MP, Cupertino A, Temple LK, Ramsdale E, Fleming FJ. New Onset Geriatric Syndromes and One-year Outcomes Following Elective Gastrointestinal Cancer Surgery. Ann Surg 2024; 279:781-788. [PMID: 37782132 DOI: 10.1097/sla.0000000000006108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To assess whether older adults who develop geriatric syndromes following elective gastrointestinal surgery have poorer 1-year outcomes. BACKGROUND Within 10 years, 70% of all cancers will occur in older adults ≥65 years old. The rise in older adults requiring major surgery has brought attention to age-related complications termed geriatric syndromes. However, whether postoperative geriatric syndromes are associated with long-term outcomes is unclear. METHODS A population-based retrospective cohort study using the New York State Cancer Registry and the Statewide Planning and Research Cooperative System was performed including patients >55 years with pathologic stage I-III esophageal, gastric, pancreatic, colon, or rectal cancer who underwent elective resection between 2004 and 2018. Those aged 55 to 64 served as the reference group. The exposure of interest was a geriatric syndrome [fracture, fall, delirium, pressure ulcer, depression, malnutrition, failure to thrive, dehydration, or incontinence (urinary/fecal)] during the surgical admission. Patients with any geriatric syndrome within 1 year of surgery were excluded. Outcomes included incident geriatric syndrome, 1-year days alive and out of the hospital, and 1-year all-cause mortality. RESULTS In this study, 37,998 patients with a median age of 71 years without a prior geriatric syndrome were included. Of those 65 years or more, 6.4% developed a geriatric syndrome. Factors associated with an incident geriatric syndrome were age, alcohol/tobacco use, comorbidities, neoadjuvant therapy, ostomies, open surgery, and upper gastrointestinal cancers. An incident geriatric syndrome was associated with a 43% higher risk of 1-year mortality (hazard ratio, 1.43; 95% confidence interval, 1.27-1.60). For those aged 65+ discharged alive and not to hospice, a geriatric syndrome was associated with significantly fewer days alive and out of hospital (322 vs 346 days, P < 0.0001). There was an indirect relationship between the number of geriatric syndromes and 1-year mortality and days alive and out of the hospital after adjusting for surgical complications. CONCLUSIONS Given the increase in older adults requiring major surgical intervention, and the establishment of geriatric surgery accreditation programs, these data suggest that morbidity and mortality metrics should be adjusted to accommodate the independent relationship between geriatric syndromes and long-term outcomes.
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Affiliation(s)
- Alexa D Melucci
- Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Anthony Loria
- Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Christopher T Aquina
- Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY
- Surgical Health Outcomes Consortium, Digestive Health and Surgery Institute, Advent Health Orlando, Orlando, FL
| | - Gabriela McDonald
- School of Medicine and Dentistry, University of Rochester, Rochester, NY
| | - Maria J Schymura
- New York State Cancer Registry, New York State Department of Health, Albany, NY
| | | | - AnaPaula Cupertino
- Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Larissa K Temple
- Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Erika Ramsdale
- Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | - Fergal J Fleming
- Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY
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Sun Z, Sui J. Delirium in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: a multicentre randomised trial. Comment on Br J Anaesth 2023; 131: 253-65. Br J Anaesth 2023; 131:e185-e186. [PMID: 37793958 DOI: 10.1016/j.bja.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Zhongpeng Sun
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jinghu Sui
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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Nomi T, Kaibori M, Hirokawa F, Ueno M, Hokuto D, Noda T, Nakai T, Ikoma H, Iida H, Kubo S. Effect of laparoscopic liver resection on postoperative delirium in elderly patients with hepatocellular carcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:1111-1118. [PMID: 37329189 DOI: 10.1002/jhbp.1341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/26/2023] [Accepted: 03/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Delirium is a multifactorial and heterogeneous syndrome that is defined as acutely altered consciousness. This retrospective multicenter study evaluated the impact of postoperative delirium after liver resection for hepatocellular carcinoma (HCC) in elderly patients. METHODS Patients aged ≥75 years, who underwent curative liver resection for HCC at nine university hospitals from April 2010 to December 2017, were evaluated to compare short- and long-term outcomes between patients with and without delirium. Risk factors for delirium were determined using multivariate regression analysis. RESULTS The rate of postoperative delirium was 14.2% (n = 80) in the study cohort of 562 patients. Multivariate analysis revealed smoking history, hypertension, sleeping pill consumption, and open liver resection as risk factors for postoperative delirium. The rate of other causes of death was significantly higher in the delirium group than in the no-delirium group although the rate of death at 1 year due to HCC or liver failure was similar between the two groups (p = .015). The 1-year mortality rates due to vascular diseases were 71.4% and 15.4% in the delirium and no-delirium groups, respectively (p = .022). The 1-, 3-, and 5-year survival rates after liver resection were 86.6%, 64.1%, and 36.5% in the delirium group and 91.3%, 71.2%, and 56.9% in the no-delirium group, respectively (p = .046). CONCLUSION The multivariate analysis revealed the possible benefits of laparoscopic liver resection in reducing the rate of postoperative delirium after liver resection for HCC in elderly patients.
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Affiliation(s)
- Takeo Nomi
- Department of Hepato-Biliary-Pancreatic Surgery, Uji Tokusyukai Medical Center, Uji, Kyoto, Japan
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Masaki Kaibori
- Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan
| | - Fumitoshi Hirokawa
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masaki Ueno
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Hokuto
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Takehiro Noda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takuya Nakai
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Hisashi Ikoma
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroya Iida
- Division of Gastrointestinal, Breast, and General Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Miyakawa T, Michihata N, Kumazawa R, Matsui H, Honda M, Yasunaga H. Short-term surgical outcomes of laparoscopic and open surgery for rectal cancer: A nationwide retrospective analysis. Asian J Endosc Surg 2023. [PMID: 36693819 DOI: 10.1111/ases.13166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/26/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Laparoscopy for treatment of rectal cancer is widely used in clinical practice. However, the safety and advantages of laparoscopy over open surgery at the national level remain unclear. We compared the short-term outcomes of laparoscopy and open surgery for rectal cancer. METHODS Using a Japanese nationwide inpatient database, this study analyzed data on patients who underwent rectal resection between July 2010 and March 2018. We performed propensity score matching analyses to compare in-hospital mortality, morbidities, blood transfusion, diverting stomas, anastomotic leakages, duration of anesthesia, postoperative length of stay, and readmission within 30 days between the laparoscopy and open surgery groups. RESULTS Among 99 137 eligible patients, propensity score matching generated 29 717 pairs. Laparoscopy was associated with lower in-hospital mortality (0.4% vs 0.6%, P = .006), overall morbidities (28.7% vs 33.2%, P < .001), and blood transfusion rate (11.5% vs 22.9%, P < .001); shorter postoperative duration of stay (16 days vs 18 days, P < .001); and longer duration of anesthesia (390 vs 310 minutes, P < .001). Grade C anastomotic leakage was not different between the groups. CONCLUSION With respect to in-hospital mortality, morbidities, blood transfusion, postoperative length of hospitalization, and readmission within 30 days, laparoscopy is advantageous over open surgery in the treatment of rectal cancer.
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Affiliation(s)
- Teppei Miyakawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.,Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Zhao B, Ji HS, Xu CY, Li DJ, Xing ZQ, Liu B, Han Y, Xia WJ, Han LH. Incidence and risk factors of postoperative delirium after pancreatic cancer surgery: a retrospective study. Surg Today 2022; 53:736-742. [DOI: 10.1007/s00595-022-02614-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/25/2022] [Indexed: 11/07/2022]
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Perioperative psychological issues and nursing care among patients undergoing minimally invasive surgeries. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2022. [DOI: 10.1016/j.lers.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Arita A, Takahashi H, Ogino T, Miyoshi N, Uemura M, Akasaka H, Sugimoto K, Rakugi H, Doki Y, Eguchi H. Grip strength as a predictor of postoperative delirium in patients with colorectal cancers. Ann Gastroenterol Surg 2022; 6:265-272. [PMID: 35261952 PMCID: PMC8889853 DOI: 10.1002/ags3.12519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/01/2021] [Accepted: 10/04/2021] [Indexed: 01/01/2023] Open
Abstract
Background The population is aging rapidly, and the population of patients who undergo surgeries is aging, too. Elderly patients have much risk of postoperative delirium, which increases the number of adverse events. The aim of this study was to investigate the risk factors of postoperative delirium in elderly patients with colorectal cancer. Methods We conducted a retrospective cohort analysis of consecutive patients aged 70 years and older who underwent surgeries for colorectal cancer at our department in the period from May 2012 to October 2019. We investigated the correlation between the incidence of postoperative delirium and Comprehensive Geriatric Assessment (CGA) scores, comorbidities, and perioperative factors. Postoperative delirium was retrospectively diagnosed by checking clinical records. Results Postoperative delirium was diagnosed in 36 of 271 patients (13.3%) with colorectal cancer. Among many comorbidities, only renal disease was significantly associated with postoperative delirium. Among the items in the CGA, age; Mini-Mental State Exam (MMSE), Barthel Index, Instrumental Activities of Daily Living (IADL), Vitality Index, and Geriatric Depression Scale (GDS) scores; and grip strength were associated with postoperative delirium. Among perioperative factors, blood transfusion was associated with postoperative delirium. Multivariate logistic regression analysis identified older age, MMSE, GDS, and grip strength as significant independent risk factors for postoperative delirium. Conclusions This single-center retrospective observational study demonstrated that grip strength is an independent predictor of postoperative delirium, along with age, MMSE, and GDS.
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Affiliation(s)
- Asami Arita
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuita CityJapan
| | - Hidekazu Takahashi
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuita CityJapan
| | - Takayuki Ogino
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuita CityJapan
| | - Norikatsu Miyoshi
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuita CityJapan
| | - Mamoru Uemura
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuita CityJapan
| | - Hiroshi Akasaka
- Department of Geriatric and General MedicineGraduate School of MedicineOsaka UniversitySuita CityJapan
| | - Ken Sugimoto
- Department of General and Geriatric MedicineGraduate School of MedicineKawasaki Medical SchoolKurashiki CityJapan
| | - Hiromi Rakugi
- Department of Geriatric and General MedicineGraduate School of MedicineOsaka UniversitySuita CityJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuita CityJapan
| | - Hidetoshi Eguchi
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuita CityJapan
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A clinical risk analysis of early post-operative delirium after laparoscopic colorectal cancer surgery in elderly patients: a retrospective study. Int J Colorectal Dis 2021; 36:1461-1468. [PMID: 33782764 DOI: 10.1007/s00384-021-03919-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Early post-operative delirium (EPOD) is a frequent complication following colorectal surgery. The present study investigated the risk factors for EPOD after laparoscopic colorectal surgery in elderly patients. METHODS A retrospective study was conducted among 208 patients ≥70 years old who underwent laparoscopic colorectal surgery. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with the EPOD. RESULTS The overall incidence of EPOD was 10.1% (21/208). The univariate analysis showed that an older age (≥80 years old; P=0.002), sleeping pill medication before surgery (P=0.037), a history of dementia (P=0.030) and cerebrovascular disease (P=0.017), elevated levels of D-dimer (P=0.016), maximum intraoperative temperature ≥37 °C (P=0.036), and non-continuous usage of droperidol with analgesia (P=0.005) were associated with EPOD. The multivariate logistic regression analysis revealed an older age (≥80 years old; odds ratio [OR]: 6.26, 95% confidence interval [CI]: 1.94-20.15, P=0.002), sleeping pill medication before surgery (OR: 5.39, 95% CI: 1.36-21.28, P=0.016), history of cerebrovascular disease (OR: 3.91, 95% CI: 1.12-13.66, P=0.033), and maximum intraoperative temperature ≥37 °C (OR: 5.10, 95% CI: 1.53-16.92, P=0.008) to be independent risk factors. When the patients were divided into groups according to the number of positive risk factors, the prevalence rate was 6.5%, 16.0%, and 63.6% for patients with 1, 2, and 3 positive risk factors, respectively. CONCLUSION Our findings suggest that an older age, sleeping pill medication before surgery, history of cerebrovascular disease, and maximum intraoperative temperature ≥37 °C are independent risk factors of EPOD after laparoscopic colorectal surgery in elderly patients.
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Factors Affecting the Length of Hospital Days After Laparoscopic Gastrectomy for Elderly Patients with Gastric Cancer. J Gastrointest Cancer 2021; 53:472-479. [PMID: 33905108 DOI: 10.1007/s12029-021-00633-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To clarify the factors affecting the length of hospitalization after laparoscopic gastrectomy based on the physical function, body composition, and postoperative course of the patients. METHODS Of the patients with gastric cancer who underwent laparoscopic resection at the Ageo Central General Hospital, Japan, during 2018-2019, 51 underwent physical therapy. Data regarding the objective variables, such as length of postoperative hospital stay, and baseline attributes, such as age, body weight, body mass index (BMI), and corrected limb muscle mass, postoperative course (operation time, the estimated blood loss, the day before walking independently), preoperative physical function (grip strength, 6-min walking distance), and preoperative respiratory function (vital capacity [VC]%, one-second rate) were collected retrospectively from the medical records and analyzed using multiple regression plots. RESULTS The most suitable hospital day model after surgery is one that incorporates the total postoperative course, respiratory function, physical function (R2 = 0.45, p < 0001), and operation time (β = 0.12, p < 0.06). The information of the day before independent walking (β = 0.68, p < 0.001) and % VC (β = -0.19, p < 0.04) was extracted as factors. CONCLUSION We concluded that the operation time, walking independence days, and % VC influence the postoperative length of hospital days.
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Guven S, Sal H, Guven ESG. Carbon Dioxide Pneumoperitoneum May Alter Ovarian Apoptosis: An Experimental Study. Gynecol Minim Invasive Ther 2021; 10:91-95. [PMID: 34040967 PMCID: PMC8140544 DOI: 10.4103/gmit.gmit_96_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/24/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives: The aim of this study was to evaluate ovarian immunohistochemical CD95 expression in a rabbit carbon dioxide pneumoperitoneum model. Materials and Methods: The study group including seven rabbits was subjected to intra-abdominal pressure (IAP) (12 mmHg); the control group was not subjected to IAP (the sham group, n = 7). At the end of the experiment, ovariectomy was performed. Immunohistochemical stained histologic specimen of the ovary with CD95 was evaluated. Based on the degree of cytoplasmic or membranous staining for CD95 from 0 (none) to 3 (severe), a microscopic apoptosis scoring system was used. Results: Statistically significantly higher apoptosis scores in ovarian surface epithelial cells (2.57 ± 0.53, vs. 1.14 ± 0.38, P = 0.002, Mann–Whitney U-test, respectively), follicular epithelial cells (2.85 ± 0.38, vs. 1.85 ± 0.38, P = 0.002, Mann–Whitney U-test, respectively), and stromal cells (2.71 ± 0.49, vs. 1.29 ± 0.49, P = 0.002, Mann–Whitney U-test, respectively) were observed in pneumoperitoneum group, compared with no-pneumoperitoneum group. Conclusion: Even at safe IAP (12 mmHg) for an acceptable operation time period, there was a significant increase in apoptosis of ovarian cells.
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Affiliation(s)
- Suleyman Guven
- Department of Obstetrics and Gynecology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Hidayet Sal
- Department of Obstetrics and Gynecology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Emine Seda Guvendag Guven
- Department of Obstetrics and Gynecology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
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Ida M, Takeshita Y, Kawaguchi M. Preoperative serum biomarkers in the prediction of postoperative delirium following abdominal surgery. Geriatr Gerontol Int 2020; 20:1208-1212. [PMID: 33084189 DOI: 10.1111/ggi.14066] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/15/2020] [Accepted: 10/02/2020] [Indexed: 01/05/2023]
Abstract
AIM Elderly patients undergoing abdominal surgery have a high risk of developing postoperative delirium. This study aimed to explore risk factors for postoperative delirium by focusing on preoperative hematologic markers, and to develop a model that would be useful in predicting the occurrence of postoperative delirium. METHODS This retrospective study included patients aged ≥65 years who underwent elective abdominal surgery under general anesthesia from January 2017 to May 2019. Patients' demographics, hematologic data and intraoperative data were recorded. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, platelet-to-white blood cell ratio and prognostic nutritional index were calculated. We evaluated risk factors of postoperative delirium assessed using a chart-based method for identification of delirium and developed a predictive model using preoperative and intraoperative data. RESULTS Of 931 eligible patients, 833 with a mean age of 73.9 years were included in the analysis. The rate of incidence of postoperative delirium was 7.3%. Age, duration of surgery and preoperative platelet-to-lymphocyte ratio or platelet-to-white blood cell ratio were statistically significant risk factors. The predictive model, which included age, duration of surgery and platelet-to-lymphocyte ratio, had the largest area under the curve of 0.77. CONCLUSIONS Age, duration of surgery and preoperative platelet-to-white blood cell ratio or platelet-to-lymphocyte ratio are associated with the development of postoperative delirium. A predictive model, which includes age, duration of surgery and preoperative platelet-to-lymphocyte ratio, is useful in predicting the development of postoperative delirium after elective abdominal surgery. Geriatr Gerontol Int 2020; 20: 1208-1212.
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Affiliation(s)
- Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Nara, Japan
| | - Yuna Takeshita
- Department of Anesthesiology, Nara Medical University, Nara, Japan
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Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth 2020; 125:492-504. [DOI: 10.1016/j.bja.2020.06.063] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/22/2020] [Accepted: 06/20/2020] [Indexed: 12/20/2022] Open
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