Incidence and risk factors of delirium in patients post pancreaticoduodenectomy

Abstract Background Post-operative delirium is an important and common complication of major abdominal surgery characterized by acute confusion with fluctuating consciousness. The aim of this study was to establish the incidence of post-operative delirium in patients undergoing a pancreaticoduodenec...

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Published inHPB (Oxford, England) Vol. 16; no. 9; pp. 864 - 869
Main Authors Gallagher, Tom K, McErlean, Sarah, O'Farrell, Aimee, Hoti, Emir, Maguire, Donal, Traynor, Oscar J, Conlon, Kevin C, Geoghegan, Justin G
Format Journal Article
LanguageEnglish
Published England Elsevier Ltd 01.09.2014
Wiley Subscription Services, Inc
BlackWell Publishing Ltd
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Summary:Abstract Background Post-operative delirium is an important and common complication of major abdominal surgery characterized by acute confusion with fluctuating consciousness. The aim of this study was to establish the incidence of post-operative delirium in patients undergoing a pancreaticoduodenectomy and to determine the risk factors for its development. Methods From a prospectively maintained database, a retrospective cohort analysis was performed of 50 consecutive patients who underwent a pancreaticoduodenectomy at the National Surgical Centre for Pancreatic Cancer in St. Vincent's University Hospital, Dublin and whose entire post-operative stay was in this institution, between July 2011 and December 2012. Two independent medical practitioners assessed all data and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual Disorder (DSM), fourth edition. Univariate and multivariate analyses were performed. Results Seven patients (14%) developed post-operative delirium. The median onset was on the second post-operative day. Older age was predictive of an increased risk of delirium post-operatively. Those who developed delirium had a significantly increased length of stay (LOS) as well as a significantly increased risk of developing at least a grade 3 complication (Clavien-Dindo classification). Conclusion This study demonstrates that post-operative delirium is associated with a more complicated recovery after a pancreaticoduodenectomy and that older age is independently predictive of its development. Focused screening may allow targeted preventative strategies to be used in the peri-operative period to reduce complications and costs associated with delirium.
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ISSN:1365-182X
1477-2574
DOI:10.1111/hpb.12266