Preoperative Risk Assessment for Delirium After Hepatic Resection in the Elderly: a Prospective Multicenter Study

• Published in: Journal of gastrointestinal surgery Vol. 25; no. 1; pp. 134 - 144
• Main Authors: Ishihara, Atsushi, Tanaka, Shogo, Ueno, Masaki, Iida, Hiroya, Kaibori, Masaki, Nomi, Takeo, Hirokawa, Fumitoshi, Ikoma, Hisashi, Nakai, Takuya, Eguchi, Hidetoshi, Shinkawa, Hiroji, Hayami, Shinya, Maehira, Hiromitsu, Shibata, Toshihiko, Kubo, Shoji
• Format: Journal Article
• Language: English
• Published: New York Springer US 2021; Springer Nature B.V
• Subjects: 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; Hypoalbuminemia; Transfer; Frailty; Healthcare support
• DOI: 10.1007/s11605-020-04562-1
• ISSN: 1091-255X

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.