Atsushi Ishihara1, Shogo Tanaka2, Masaki Ueno3, Hiroya Iida4, Masaki Kaibori5, Takeo Nomi6, Fumitoshi Hirokawa7, Hisashi Ikoma8, Takuya Nakai9, Hidetoshi Eguchi10, Hiroji Shinkawa1, Shinya Hayami3, Hiromitsu Maehira4, Toshihiko Shibata1, Shoji Kubo1. 1. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan. 2. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan. m8827074@msic.med.osaka-cu.ac.jp. 3. Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. 4. Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan. 5. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan. 6. Department of Surgery, Nara Medical University, Kashihara, Nara, Japan. 7. Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan. 8. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. 9. Department of Surgery, Faculty of Medicine, Kinki University, Osaka-Sayama, Osaka, Japan. 10. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
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.
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.
Entities:
Keywords:
Frailty; Healthcare support; Hypoalbuminemia; Transfer