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Li Y, Li Z, Lv Q, Gu Y, Qi Y, Li J, Liu Y, Ma G. Prevalence and risk factors of postoperative delirium in tumor patients after free flap reconstruction: A systematic review and meta-analysis of case-control studies. Surgery 2024; 176:906-917. [PMID: 38910046 DOI: 10.1016/j.surg.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/12/2024] [Accepted: 05/06/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Postoperative delirium is a severe complication of flap transplantation surgery, adversely affecting surgical prognoses. The intricate pathophysiology of postoperative delirium renders the elucidation of its risk factors challenging. This research aims to delineate the prevalence and the specific risk factors of postoperative delirium in patients with cancer undergoing free flap reconstruction through a systematic review and meta-analysis to enlighten proactive prevention measures. METHODS The researchers systematically queried both the international and Chinese databases. Searches were performed for publications from inception until September 14, 2023, using the terms "free tissue flaps," "delirium," "neoplasms," and "risk factors." Data synthesis and statistical analysis were conducted using Stata SE (version 15.0) to calculate the combined effect size for identified risk factors. Reported outcomes included weighted mean differences or odds ratios with their respective 95% confidence intervals. RESULTS Twelve case-control studies were included (ntotal = 3,256). Among them, 515 patients developed postoperative delirium after free flap surgery, compared with 2,741 patients who did not. The outcomes suggest that the risk factors include but are not limited to age, male, late neoplasm staging, use of hypnotic or antipsychotic, history of background diseases, psychiatric review, tracheotomy, and impaired wound healing. In contrast, early neoplasm staging and others are the protective factors with statistical significance. Multivariate analysis further identified significant correlations between preoperative albumin, perioperative blood transfusion, sleep disturbance, postoperative visual analog scale, postoperative albumin, smoking, and the appearance of postoperative delirium. CONCLUSION The determined risk factors were grouped into preoperative, intraoperative, and postoperative categories substantiated by current data to present instructions for postoperative delirium prevention.
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Affiliation(s)
- Yifei Li
- Department of General Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China
| | - Zhifeng Li
- First Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, Peoples Republic of China
| | - Qianwen Lv
- Department of Fat Grafting, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China
| | - Yunpeng Gu
- Department of Fat Grafting, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China
| | - Yue Qi
- Department of Fat Grafting, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China
| | - Jiyang Li
- Department of Fat Grafting, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China
| | - Yicheng Liu
- Department of General Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China
| | - Guie Ma
- Department of General Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Peoples Republic of China.
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Alhammadi E, Kuhlmann JM, Rana M, Frohnhofen H, Moellmann HL. Postoperative delirium in oral and maxillofacial surgery: a scoping review. Head Face Med 2024; 20:39. [PMID: 39044223 PMCID: PMC11265362 DOI: 10.1186/s13005-024-00439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/12/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) in the oral and maxillofacial settings has gained more attention in recent decades. Due to advances in medical technology, treatment possibilities have expanded treatment for elderly and frail patients. This scoping review explores the correlation between POD and oral and maxillofacial surgery, summarizing screening and management protocols and identifying risk factors in this surgical field. METHODS This review follows the Scoping Review extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR). A comprehensive literature search was performed using multiple databases, focusing on articles published from 2002 to 2023 that discuss delirium in oral and maxillofacial surgery settings. The review was registered beforehand in the Open Science Framework ( https://osf.io/r2ebc ). RESULTS From the initial 644 articles, 68 met the inclusion criteria. These studies highlighted the significant heterogeneity in POD diagnosis methods. The review identifies multiple risk factors across the preoperative, intraoperative, and postoperative phases that influence the occurrence of POD. Significant and independent risk factors in multiple regression analysis were highlighted, creating a clinical prediction list for the occurrence of POD. CONCLUSION It is crucial to preoperatively identify patients at risk for POD and actively modify these risks throughout the patient's hospital stay. Implementing nonpharmacological preventive measures for at-risk patients is recommended to decrease the incidence of POD. Future research should focus on creating standardized specialty-specific protocols incorporating validated assessment tools and addressing the full spectrum of risk factors associated with POD.
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Affiliation(s)
- Eman Alhammadi
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany.
- Dubai Health, Dubai, United Arab Emirates.
| | - Julian Max Kuhlmann
- Heinrich-Heine-Universität Düsseldorf, Universitätsstrasse 1, Düsseldorf, 40225, Germany
| | - Majeed Rana
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Helmut Frohnhofen
- Orthopedics and Trauma Surgery, University Hospital Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany
| | - Henriette Louise Moellmann
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany.
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Kandula RA, Borne G, Kandregula S, Beyl R, Nathan CAO. Impact of Dementia on the Postoperative Outcomes in Patients Undergoing Surgery for Head and Neck Cancers: A National Study. Laryngoscope 2024; 134:1258-1264. [PMID: 37602750 DOI: 10.1002/lary.30988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/06/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Dementia, a growing concern among the elderly, has an increased poor postoperative outcome that goes unrecognized by many. Our study aims to establish if dementia plays a role in the outcomes of head and neck cancer patients that undergo resections. METHODS We queried the National Inpatient Sample (NIS) database from 2016 to 2019 with a primary diagnosis of head and neck cancer who underwent surgical resection. Outcomes analyzed include postoperative delirium, ICU stay, complications, length of stay, and non-routine discharge. RESULTS A total of 77095 patients were included, of which 1140 patients had dementia. The mean age of the patients with dementia was 77.5 years (±9.1) versus 63.2 years (±12.1) with no dementia. Dementia patients had a higher non-home discharge rate (77.2% vs 46.8%, p = <0.001), extended length of stay (10.9 days ±14.7 vs 7.9 days ±8.8), postoperative delirium (15.4% vs 1.5%, p = <0.001), and longer ICU stay (8.3% vs 5.8%) as compared with patients with no dementia. A higher number of patients with Dementia were placed in long-term facilities (53.5% vs 14.6%) postoperatively. More dementia patients (7.9% vs 0.9%) were transferred in from another health care facility for surgery. Dementia was associated with higher odds of delirium (OR, 6.36; 95% CI, 5.2-7.77), non-routine discharge (OR, 2.05; 95% CI, 1.76-2.3), ventilation (OR, 0.8; 95% CI, 0.6-1.05), and length of stay (estimate 3.01, 95% CI, 1.84-4.184). CONCLUSION Preoperative dementia significantly impacts postoperative delirium, non-home discharge, and extended length of stay in head and neck cancer patients undergoing surgery. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1258-1264, 2024.
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Affiliation(s)
- Rema Anisha Kandula
- Department of Otolaryngology-Head & Neck Surgery, LSU Health & Feist-Weiller Cancer Center, Shreveport, Louisiana, U.S.A
| | - Grant Borne
- School of Medicine, LSU Health, Shreveport, Louisiana, U.S.A
| | | | - Robbie Beyl
- Department of Biostatistics, Pennington Institute of Biomedical Research, Baton Rouge, Louisiana, U.S.A
| | - Cherie-Ann O Nathan
- Department of Otolaryngology-Head & Neck Surgery, LSU Health & Feist-Weiller Cancer Center, Shreveport, Louisiana, U.S.A
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Sun J, Ji Y, Huang J, Zhao H. Risk Factors for Postoperative Delirium in Patients Undergoing Major Head and Neck Cancer Surgery: A Meta-analysis. Cancer Nurs 2024:00002820-990000000-00216. [PMID: 38416070 DOI: 10.1097/ncc.0000000000001330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Postoperative delirium (POD) is a common and serious complication after extensive surgery. Understanding the independent and potential modifiable risk factors leading to POD in patients with head and neck cancer (HNC) can provide information for future intervention trials aimed at reducing this risk. OBJECTIVE To systematically analyze influencing factors of POD in patients with HNC and identify high-risk individuals for delirium. METHODS PubMed, EMBASE, Scopus, OVID, and Cochrane Library were searched for publications prior to June 2023. Comparative studies in which POD risk factors were investigated were identified following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Newcastle-Ottawa Scale was used to evaluate the study quality. Pooled odds ratios or mean differences for individual risk factors were estimated using the Mantel-Haenszel and inverse-variance methods. RESULTS This review included 17 studies with a total of 4188 patients undergoing HNC surgery. The pooled prevalence of POD was 15.44%. Based on pooled analysis, 8 significant risk factors were identified including age older than 70 years, male sex, history of smoking, history of psychiatric disorder, American Society of Anesthesiologists score, albumin level, postoperative insomnia, and fluid intake. CONCLUSION In the present study, 8 factors that correlated with POD were identified: 6 preoperative, 1 intraoperative, and 1 postoperative. IMPLICATIONS FOR PRACTICE The influencing factors for POD in patients with HNC were identified that can provide a reference for improving the psychological state of the patient population and further development of effective treatment interventions.
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Affiliation(s)
- Jiaqi Sun
- Author Affiliations: Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology (Ms Sun), School of Nursing (Mss Ji and Huang) and Department of Pediatric Dentistry, School and Hospital of Stomatology (Mrs Zhao), China Medical University, Shenyang
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Hoshi I, Abe R, Onodera K, Ohashi Y, Kawai T, Miyamoto I, Chiba T, Takeda Y, Yamada H. Osteosarcoma of the Mandible in an Elderly Patient. Case Rep Dent 2022; 2022:2622551. [PMID: 35342653 PMCID: PMC8947915 DOI: 10.1155/2022/2622551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/23/2022] [Indexed: 02/08/2023] Open
Abstract
Osteosarcoma is a malignant tumor in which the cancerous cells produce an osteoid matrix or mineralized bone. Jaw bones are affected in 6% of all osteosarcomas and are the fourth most common site of origin. Surgical treatment of osteosarcoma in elderly patients is rarely reported. Here, we report successful treatment of osteosarcoma arising in the mandible of a 90-year-old man. The patient was referred to our institution for diagnosis and treatment of an oral lesion. Intraoral examination revealed that a hard mass measuring 35 × 27 mm was located on the floor of the oral cavity, attached to the bone, and its growth displaced the tongue posteriorly. Therefore, he experienced difficulty in speech and swallowing. Biopsy of the mandibular mass was suspicious for chondrosarcoma. Preoperative examination did not detect critical risks for general anesthesia or surgery. Based on a clinical diagnosis of a malignant bone tumor of the mandible, segmental mandibular resection with reconstruction using a titanium plate was performed. Surgical site infection occurred on postoperative day 12, which was resolved by drainage, local irrigation, and administration of antibiotics. There was no delirium or cardiovascular or pulmonary complications. Surgery resolved the patient's difficulties in speech and swallowing. There was no evidence of tumor recurrence or metastasis 4 years after surgery. This case showed that it was not necessary to exclude surgical treatment merely because the patient was 90 years old. Indications for surgery should be determined individually to improve the patient's quality of life.
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Affiliation(s)
- Isao Hoshi
- 1Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
| | - Ryosuke Abe
- 2Department of Oral and Maxillofacial Surgery, Iwate Prefectural Central Hospital, Morioka 020-0066, Japan
| | - Kei Onodera
- 1Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
| | - Yu Ohashi
- 1Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
| | - Tadashi Kawai
- 1Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
| | - Ikuya Miyamoto
- 1Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
| | - Toshimi Chiba
- 3Division of Internal Medicine, Department of Oral Medicine, Iwate Medical University, Morioka 020-8505, Japan
| | - Yasunori Takeda
- 4Division of Clinical Pathology, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
| | - Hiroyuki Yamada
- 1Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, School of Dentistry, Iwate Medical University, Morioka 020-8505, Japan
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Goldstein DP, Blasco M, de Almeida J, Su J, Xu W, Cohen M, Sklar M, Alibhai S. Cognitive Impairment and Delirium in Older Patients Undergoing Major Head and Neck Surgery. Otolaryngol Head Neck Surg 2021; 167:97-99. [PMID: 34546809 PMCID: PMC9251740 DOI: 10.1177/01945998211045293] [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] [Indexed: 11/16/2022]
Abstract
The study objective was to measure the prevalence and predictors of cognitive
impairment (CI) and delirium. Adults undergoing major head and neck cancer
surgery completed the Clock Draw Test to screen for CI, defined as a score of 0
or 1. Postoperative delirium was recorded. Predictors of delirium and length of
stay were assessed by univariate logistic regression and the latter with
multivariate linear regression. Overall 274 patients were included, of which 47%
had a Clock Draw Test score of 0 or 1. Post-operative delirium occurred in 17
(6%). CI was a predictor of postoperative delirium (odds ratio, 3.9; 95% CI,
1.2-12; P = .02). Postoperative delirium was a predictor of
increased length of stay (adjusted odds ratio, 1.30; 95% CI, 1.07-1.57;
P = .0073) on multivariate regression while baseline Clock
Draw Test result was not a predictor on univariate regression
(P = .98). Screening for CI can help predict delirium and
facilitate targeted interventions in the postoperative period.
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Affiliation(s)
- David P Goldstein
- Departments of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Michael Blasco
- Departments of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - John de Almeida
- Departments of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Jie Su
- Department of Biostatistics, Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Wei Xu
- Department of Biostatistics, Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Marc Cohen
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael Sklar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Shabbir Alibhai
- Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
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