Preoperative Risk Assessment for Delirium After Hepatic Resection in the Elderly: a Prospective Multicenter Study
Background Hepatic resection often results in delirium in preoperatively self-sufficient elderly people. The association of frailty with postoperative delirium remains unclear, and preoperative risk assessment, including frailty, of postoperative delirium has not been established. Methods This prosp...
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Published in | Journal of gastrointestinal surgery Vol. 25; no. 1; pp. 134 - 144 |
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Main Authors | , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer US
2021
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
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Abstract | Background
Hepatic resection often results in delirium in preoperatively self-sufficient elderly people. The association of frailty with postoperative delirium remains unclear, and preoperative risk assessment, including frailty, of postoperative delirium has not been established.
Methods
This prospective multicenter study included 295 independently living patients aged ≥ 65 years scheduled for initial hepatic resection. All patients answered the phenotypic frailty index Kihon Checklist, which is a self-reporting list of 25 questions, within a week before surgery. The risk factors for postoperative delirium were investigated. Patients who scored ≥ 4 in the Intensive Care Delirium Screening Checklist were designated as having postoperative delirium.
Results
Delirium developed after liver resection in 22 of 295 patients (7.5%). Total Kihon Checklist score (≥ 6 points), age (≥ 75 years), and serum albumin concentration (≤ 3.7 g/dL) were the independent risk factors for postoperative delirium. The proportion of patients with postoperative delirium was 0% in those with no applicable risk factors, 3.2% in those with one applicable risk factor, 12.0% in those with two applicable risk factors, and 40.9% in those with all three factors (
p
< 0.001). The area under the receiver operating characteristic curve for this risk assessment for predicting postoperative delirium was 0.842.
Conclusion
The use of these three factors for preoperative risk assessment may be effective in predicting and preparing for delirium after hepatic resection in elderly patients. |
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AbstractList | Background
Hepatic resection often results in delirium in preoperatively self-sufficient elderly people. The association of frailty with postoperative delirium remains unclear, and preoperative risk assessment, including frailty, of postoperative delirium has not been established.
Methods
This prospective multicenter study included 295 independently living patients aged ≥ 65 years scheduled for initial hepatic resection. All patients answered the phenotypic frailty index Kihon Checklist, which is a self-reporting list of 25 questions, within a week before surgery. The risk factors for postoperative delirium were investigated. Patients who scored ≥ 4 in the Intensive Care Delirium Screening Checklist were designated as having postoperative delirium.
Results
Delirium developed after liver resection in 22 of 295 patients (7.5%). Total Kihon Checklist score (≥ 6 points), age (≥ 75 years), and serum albumin concentration (≤ 3.7 g/dL) were the independent risk factors for postoperative delirium. The proportion of patients with postoperative delirium was 0% in those with no applicable risk factors, 3.2% in those with one applicable risk factor, 12.0% in those with two applicable risk factors, and 40.9% in those with all three factors (
p
< 0.001). The area under the receiver operating characteristic curve for this risk assessment for predicting postoperative delirium was 0.842.
Conclusion
The use of these three factors for preoperative risk assessment may be effective in predicting and preparing for delirium after hepatic resection in elderly patients. Hepatic resection often results in delirium in preoperatively self-sufficient elderly people. The association of frailty with postoperative delirium remains unclear, and preoperative risk assessment, including frailty, of postoperative delirium has not been established. This prospective multicenter study included 295 independently living patients aged ≥ 65 years scheduled for initial hepatic resection. All patients answered the phenotypic frailty index Kihon Checklist, which is a self-reporting list of 25 questions, within a week before surgery. The risk factors for postoperative delirium were investigated. Patients who scored ≥ 4 in the Intensive Care Delirium Screening Checklist were designated as having postoperative delirium. Delirium developed after liver resection in 22 of 295 patients (7.5%). Total Kihon Checklist score (≥ 6 points), age (≥ 75 years), and serum albumin concentration (≤ 3.7 g/dL) were the independent risk factors for postoperative delirium. The proportion of patients with postoperative delirium was 0% in those with no applicable risk factors, 3.2% in those with one applicable risk factor, 12.0% in those with two applicable risk factors, and 40.9% in those with all three factors (p < 0.001). The area under the receiver operating characteristic curve for this risk assessment for predicting postoperative delirium was 0.842. The use of these three factors for preoperative risk assessment may be effective in predicting and preparing for delirium after hepatic resection in elderly patients. BackgroundHepatic resection often results in delirium in preoperatively self-sufficient elderly people. The association of frailty with postoperative delirium remains unclear, and preoperative risk assessment, including frailty, of postoperative delirium has not been established.MethodsThis prospective multicenter study included 295 independently living patients aged ≥ 65 years scheduled for initial hepatic resection. All patients answered the phenotypic frailty index Kihon Checklist, which is a self-reporting list of 25 questions, within a week before surgery. The risk factors for postoperative delirium were investigated. Patients who scored ≥ 4 in the Intensive Care Delirium Screening Checklist were designated as having postoperative delirium.ResultsDelirium developed after liver resection in 22 of 295 patients (7.5%). Total Kihon Checklist score (≥ 6 points), age (≥ 75 years), and serum albumin concentration (≤ 3.7 g/dL) were the independent risk factors for postoperative delirium. The proportion of patients with postoperative delirium was 0% in those with no applicable risk factors, 3.2% in those with one applicable risk factor, 12.0% in those with two applicable risk factors, and 40.9% in those with all three factors (p < 0.001). The area under the receiver operating characteristic curve for this risk assessment for predicting postoperative delirium was 0.842.ConclusionThe use of these three factors for preoperative risk assessment may be effective in predicting and preparing for delirium after hepatic resection in elderly patients. |
Author | Nakai, Takuya Maehira, Hiromitsu Shibata, Toshihiko Ikoma, Hisashi Eguchi, Hidetoshi Kaibori, Masaki Nomi, Takeo Shinkawa, Hiroji Hayami, Shinya Ishihara, Atsushi Tanaka, Shogo Ueno, Masaki Kubo, Shoji Iida, Hiroya Hirokawa, Fumitoshi |
Author_xml | – sequence: 1 givenname: Atsushi surname: Ishihara fullname: Ishihara, Atsushi organization: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine – sequence: 2 givenname: Shogo surname: Tanaka fullname: Tanaka, Shogo email: m8827074@msic.med.osaka-cu.ac.jp organization: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine – sequence: 3 givenname: Masaki surname: Ueno fullname: Ueno, Masaki organization: Second Department of Surgery, Wakayama Medical University – sequence: 4 givenname: Hiroya surname: Iida fullname: Iida, Hiroya organization: Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science – sequence: 5 givenname: Masaki surname: Kaibori fullname: Kaibori, Masaki organization: Department of Surgery, Hirakata Hospital, Kansai Medical University – sequence: 6 givenname: Takeo surname: Nomi fullname: Nomi, Takeo organization: Department of Surgery, Nara Medical University – sequence: 7 givenname: Fumitoshi surname: Hirokawa fullname: Hirokawa, Fumitoshi organization: Department of General and Gastroenterological Surgery, Osaka Medical College – sequence: 8 givenname: Hisashi surname: Ikoma fullname: Ikoma, Hisashi organization: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine – sequence: 9 givenname: Takuya surname: Nakai fullname: Nakai, Takuya organization: Department of Surgery, Faculty of Medicine, Kinki University – sequence: 10 givenname: Hidetoshi surname: Eguchi fullname: Eguchi, Hidetoshi organization: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University – sequence: 11 givenname: Hiroji surname: Shinkawa fullname: Shinkawa, Hiroji organization: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine – sequence: 12 givenname: Shinya surname: Hayami fullname: Hayami, Shinya organization: Second Department of Surgery, Wakayama Medical University – sequence: 13 givenname: Hiromitsu surname: Maehira fullname: Maehira, Hiromitsu organization: Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science – sequence: 14 givenname: Toshihiko surname: Shibata fullname: Shibata, Toshihiko organization: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine – sequence: 15 givenname: Shoji surname: Kubo fullname: Kubo, Shoji organization: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32193848$$D View this record in MEDLINE/PubMed |
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Snippet | Background
Hepatic resection often results in delirium in preoperatively self-sufficient elderly people. The association of frailty with postoperative delirium... Hepatic resection often results in delirium in preoperatively self-sufficient elderly people. The association of frailty with postoperative delirium remains... BackgroundHepatic resection often results in delirium in preoperatively self-sufficient elderly people. The association of frailty with postoperative delirium... BACKGROUNDHepatic resection often results in delirium in preoperatively self-sufficient elderly people. The association of frailty with postoperative delirium... |
SourceID | proquest crossref pubmed springer |
SourceType | Aggregation Database Index Database Publisher |
StartPage | 134 |
SubjectTerms | Aged Delirium Delirium - diagnosis Delirium - epidemiology Delirium - etiology Frailty Gastroenterology Geriatric Assessment Humans Liver Medicine Medicine & Public Health Older people Original Article Postoperative Complications - diagnosis Postoperative Complications - epidemiology Postoperative Complications - etiology Prospective Studies Risk Assessment Risk Factors Surgery |
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Title | Preoperative Risk Assessment for Delirium After Hepatic Resection in the Elderly: a Prospective Multicenter Study |
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