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The incidence and risk factors associated with postoperative delirium in geriatric patients undergoing surgery for suspected gynecologic malignancies.

Abstract：

BACKGROUND:The incidence of postoperative delirium (PD) in the elderly ranges between 3-60% but has never been examined in gynecologic oncology. Our goal was to identify pre, intra, and postoperative risk factors associated with the development of PD. METHODS:English speaking women of 60 years and above undergoing major surgery for suspected gynecologic malignancies were invited to participate. Enrolled patients were administered a pre and postoperative Mini-Mental State Exam (MMSE), and the postoperative Confusion Assessment Method was used to diagnosis PD. Pre, intra, and postoperative clinicopathology parameters were collected. Statistics included the Pearson chi-squared tests and multivariate logistic regression. RESULTS:Eighteen of a total of 103 patients (17.5%) developed PD. Univariate analysis revealed significant associations (p<0.05) between the development of delirium and age, albumin level, Charlson comorbidity index, performance status, dementia, level of education, number of pre and postoperative medications, prolonged oxygen or Foley catheter usage (>2 d), increased narcotic use (above standard regimens), postoperative transfusion, bed restriction and change in MMSE scores (pre vs. post). Using multivariate logistic regression analysis, older patients (p=0.0002), on multiple medications (p=0.008), given additional narcotic doses (p<0.0001) were at highest risk for the development of delirium. Intraoperative parameters were not correlated with outcome. CONCLUSIONS:PD is a common complication in older women undergoing major gynecologic surgery. Increased narcotics, age, and preoperative medications were strongly associated with this adverse event. Prevention needs to focus on i) identifying patients at higher risk for PD based on preoperative parameters, and ii) eliminating known postoperative risk factors.

journal_name

Gynecol Oncol

journal_title

Gynecologic oncology

authors

McAlpine JN,Hodgson EJ,Abramowitz S,Richman SM,Su Y,Kelly MG,Luther M,Baker L,Zelterman D,Rutherford TJ,Schwartz PE

doi

10.1016/j.ygyno.2008.02.016

subject

Has Abstract

pub_date

2008-05-01 00:00:00

pages

296-302

issue

eissn

0090-8258

issn

1095-6859

pii

S0090-8258(08)00166-2

journal_volume

109

pub_type

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The incidence and risk factors associated with postoperative delirium in geriatric patients undergoing surgery for suspected gynecologic malignancies.