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Incidence, risk factors, and complications of postoperative delirium in elderly patients undergoing radical cystectomy.

Abstract：

OBJECTIVE:To identify the risk factors for, and complications associated with, the development of delirium after radical cystectomy. MATERIALS AND METHODS:From July 2008 to December 2009, 59 patients, aged ≥65 years and undergoing radical cystectomy, were prospectively enrolled. The baseline cognitive status was assessed using the Mini-Mental Status Examination. Postoperative delirium was assessed using the Confusion Assessment Method. RESULTS:A total of 49 patients completed the surgery and all assessments. The incidence of postoperative delirium was 29%, with duration of 1-5 days. On univariate analysis, older age and preoperative Mini-Mental Status Examination score were associated with postoperative delirium. On multivariate analysis, only age was associated with postoperative delirium (odds ratio 1.52, 95% confidence interval 1.04-2.22, P=.03). The 2 groups did not differ in pathologic stage, length of surgery, intraoperative and postoperative narcotic usage, body mass index, age-adjusted Charlson comorbidity index, activities of daily living scores, smoking history, preoperative hematocrit, estimated blood loss, urinary tract infection, interval to a regular diet, or length of hospital stay. The patients who developed postoperative delirium were more likely to undergo readmission (odds ratio 10.7, 95% confidence interval 2.2-51.8, P=.01) and reoperation (odds ratio 9.2, 95% confidence interval 1.5-55.3, P=.03) but did not differ in the 90-day and 1-year mortality rates or incidence of postoperative complications. CONCLUSION:In patients aged≥65 years, a lower preoperative Mini-Mental Status Examination score and older age were significantly associated with the development of postcystectomy delirium, as measured using the Confusion Assessment Method. The patients who developed delirium were more likely to undergo readmission and reoperation. Larger studies with multiple surgeons are needed to validate these findings.

journal_name

Urology

journal_title

Urology

authors

Large MC,Reichard C,Williams JT,Chang C,Prasad S,Leung Y,DuBeau C,Bales GT,Steinberg GD

doi

10.1016/j.urology.2012.07.086

subject

Has Abstract

pub_date

2013-01-01 00:00:00

pages

123-8

issue

1

eissn

0090-4295

issn

1527-9995

pii

S0090-4295(12)01046-1

journal_volume

81

pub_type

杂志文章

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