#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Postoperative delirium after lung resection for primary lung cancer: Risk factors, risk scoring system, and prognosis


Autoři: Kazuki Hayashi aff001;  Makoto Motoishi aff002;  Satoru Sawai aff003;  Kanna Horimoto aff003;  Jun Hanaoka aff001
Působiště autorů: Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan aff001;  Department of Thoracic Surgery, Mitsubishikyoto Hospital, Kyoto, Japan aff002;  Department of Thoracic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0223917

Souhrn

Delirium is a common post-surgical complication, but few studies have examined postoperative delirium following lung cancer surgery. The purpose of this study was to clarify the risk factors of postoperative delirium, to construct a useful scoring system, and to clarify the relationship between delirium and prognosis after lung cancer surgery. We retrospectively analyzed data from 570 patients who underwent surgery for primary lung cancer. Logistic regression analysis was used to determine the effects of various factors on the onset of delirium. Kaplan–Meier analysis was performed to determine the relationship between delirium and prognosis. Postoperative delirium occurred in 6.7% of the patients. Three risk factors were identified, and the risk scores were determined as follows: 2×(cerebrovascular disease history) + 1×(squamous cell carcinoma) + 1×(age older than 75 years). Scores 0–1 denoted low risk, 2 denoted intermediate risk, and 3–4 denoted high risk. Additionally, we found that patients who developed delirium had significantly shorter overall survival. However, there was no difference in the frequency between cancer-related death and non-cancer related death when comparing the delirium and non-delirium groups. We identified the risk factors, i.e., cerebrovascular disease history, squamous cell carcinoma, and age older than 75 years, that determine the onset of delirium after lung cancer surgery and constructed a useful scoring system. In addition, although the prognosis of the delirium group was poor, the factor that determines prognosis may not be cancer per se but vulnerability in the patient background.

Klíčová slova:

Cerebrovascular diseases – Surgical and invasive medical procedures – Lung and intrathoracic tumors – Surgical resection – Surgical oncology – Prognosis – Squamous cell carcinomas – Cancer risk factors


Zdroje

1. Marcantonio ER. Delirium in hospitalized older adults. N Engl J Med. 2017;377: 1456–1466. doi: 10.1056/NEJMcp1605501 29020579

2. Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA J Am Med Assoc. 1994;271: 134–139.

3. Martin B-J, Buth KJ, Arora RC, Baskett RJ. Delirium as a predictor of sepsis in post-coronary artery bypass grafting patients: a retrospective cohort study. Crit Care. 2010;14: R171. doi: 10.1186/cc9273 20875113

4. Veiga D, Luis C, Parente D, Fernandes V, Botelho M, Santos P, et al. Postoperative delirium in intensive care patients: risk factors and outcome. Rev Bras Anestesiol. 2012;62: 469–483. doi: 10.1016/S0034-7094(12)70146-0 22793963

5. Rudolph JL, Jones RN, Rasmussen LS, Silverstein JH, Inouye SK, Marcantonio ER. Independent vascular and cognitive risk factors for postoperative delirium. Am J Med. 2007;120: 807–813. doi: 10.1016/j.amjmed.2007.02.026 17765051

6. Gallagher TK, McErlean S, O’Farrell A, Hoti E, Maguire D, Traynor OJ, et al. Incidence and risk factors of delirium in patients post pancreaticoduodenectomy. HPB (Oxford). 2014;16: 864–869.

7. Park SA, Tomimaru Y, Shibata A, Miyagawa S, Noguchi K, Dono K. Incidence and risk factors for postoperative delirium in patients after hepatectomy. World J Surg. 2017;41: 2847–2853. doi: 10.1007/s00268-017-4079-3 28608014

8. Vasunilashorn SM, Dillon ST, Inouye SK, Ngo LH, Fong TG, Jones RN, et al. High C-reactive protein predicts delirium incidence, duration, and feature severity after major noncardiac surgery. J Am Geriatr Soc. 2017;65: e109–116. doi: 10.1111/jgs.14913 28555781

9. Tei M, Wakasugi M, Kishi K, Tanemura M, Akamatsu H. Incidence and risk factors of postoperative delirium in elderly patients who underwent laparoscopic surgery for colorectal cancer. Int J Colorectal Dis. 2016;31: 67–73. doi: 10.1007/s00384-015-2335-2 26243471

10. Galyfos GC, Geropapas GE, Sianou A, Sigala F, Filis K. Risk factors for postoperative delirium in patients undergoing vascular surgery. J Vasc Surg. 2017;66: 937–946. doi: 10.1016/j.jvs.2017.03.439 28583731

11. Lynch EP, Lazor MA, Gellis JE, Orav J, Goldman L, Marcantonio ER. The impact of postoperative pain on the development of postoperative delirium. Anesth Analg. 1998;86: 781–785. doi: 10.1097/00000539-199804000-00019 9539601

12. Marcantonio ER, Goldman L, Orav EJ, Cook EF, Thomas HL. The association of intraoperative factors with the development of postoperative delirium. Am J Med. 1998;105: 380–384. doi: 10.1016/s0002-9343(98)00292-7 9831421

13. Shah S, Weed HG, He X, Agrawal A, Ozer E, Schuller DE. Alcohol-related predictors of delirium after major head and neck cancer surgery. Arch Otolaryngol Head Neck Surg. 2012;138: 266–271. doi: 10.1001/archoto.2011.1456 22431871

14. Yildizeli B, Oǧuzhan Özyurtkan M, Kuşcu K, Bekiroǧlu N, Yüksel M. Factors associated with postoperative delirium after thoracic surgery. Ann Thorac Surg. 2005;79: 1004–1009. doi: 10.1016/j.athoracsur.2004.06.022 15734423

15. Özyurtkan MO, Yildizeli B, Kuşçu K, Bekiroǧlu N, Bostanci K, Batirel HF, et al. Postoperative psychiatric disorders in general thoracic surgery: incidence, risk factors and outcomes. Eur J Cardiothorac Surg. 2010;37: 1152–1157. doi: 10.1016/j.ejcts.2009.11.047 20117012

16. Aakerlund LP, Rosenberg J. Postoperative delirium: treatment with supplementary oxygen. Br J Anaesth. 1994;72: 286–290. doi: 10.1093/bja/72.3.286 8130045

17. Root JC, Pryor KO, Downey R, Alici Y, Davis ML, Holodny A, et al. Association of pre-operative brain pathology with post-operative delirium in a cohort of non-small cell lung cancer patients undergoing surgical resection. Psychooncology. 2013;22: 2087–2094. doi: 10.1002/pon.3262 23457028

18. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013. pp. 596–598.

19. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Revised. Washington: American Psychiatric Publishing; 2000.

20. Pandharipande PP, Ely EW, Arora RC, Balas MC, Boustani MA, La Calle GH, et al. The intensive care delirium research agenda: a multinational, interprofessional perspective. Intensive Care Med. 2017;43: 1329–1339. doi: 10.1007/s00134-017-4860-7 28612089

21. Luetz A, Heymann A, Radtke FM, Chenitir C, Neuhaus U, Nachtigall I, et al. Different assessment tools for intensive care unit delirium: Which score to use? Crit Care Med. 2010;38: 409–418. doi: 10.1097/CCM.0b013e3181cabb42 20029345

22. Gusmao-Flores D, Salluh JI, Chalhub RÁ, Quarantini LC. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive caredelirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Crit Care. 2012;16: R115. doi: 10.1186/cc11407 22759376

23. Sakaguchi T, Watanabe M, Kawasaki C, Kuroda I, Abe H, Date M, et al. A novel scoring system to predict delirium and its relationship with the clinical course in patients with acute decompensated heart failure. J Cardiol. 2018;71: 564–569. doi: 10.1016/j.jjcc.2017.11.011 29287809

24. Winawer N. Postoperative delirium. Med Clin North Am 2001;85: 1229–1239. doi: 10.1016/s0025-7125(05)70374-6 11565496

25. Trzepacz PT. The neuropathogenesis of delirium: a need to focus our research. Psychosomatics. 1994;35: 374–391. doi: 10.1016/S0033-3182(94)71759-X 7916159

26. Takeuchi M, Takeuchi H, Fujisawa D, Miyajima K, Yoshimura K, Hashiguchi S, et al. Incidence and risk factors of postoperative delirium in patients with esophageal cancer. Ann Surg Oncol. 2012;19: 3963–3970. doi: 10.1245/s10434-012-2432-1 22699802

27. Koebrugge B, Koek HL, van Wensen RJ, Dautzenberg PL, Bosscha K. Delirium after abdominal surgery at a surgical ward with a high standard of delirium care: incidence, risk factors and outcomes. Dig Surg. 2009;26: 63–68. doi: 10.1159/000194947 19169032

28. OECD Data. Length of hospital stay. Available from https://data.oecd.org/healthcare/length-of-hospital-stay.htm. Accessed 24 March 2019

29. Kawase A, Yoshida J, Ishii G, Nakao M, Aokage K, Hishida T, et al. Differences between squamous cell carcinoma and adenocarcinoma of the lung: are adenocarcinoma and squamous cell carcinoma prognostically equal? Jpn J Clin Oncol. 2012;42: 189–195. doi: 10.1093/jjco/hyr188 22210923

30. Murakawa K, Kitamura Y, Watanabe S, Hongo S, Shinomiya K, Sendo T. Clinical risk factors associated with postoperative delirium and evaluation of delirium management and assessment team in lung and esophageal cancer patients. J Pharm Heal Care Sci. 2015;1: 4.


Článok vyšiel v časopise

PLOS One


2019 Číslo 11
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Kurzy

Zvýšte si kvalifikáciu online z pohodlia domova

Aktuální možnosti diagnostiky a léčby litiáz
nový kurz
Autori: MUDr. Tomáš Ürge, PhD.

Všetky kurzy
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#