Incidence and Risk Factors of Postoperative Delirium following Pancreatic Surgery: Does the Administration of TJ-54 Reduce the Incidence of Delirium

Abstract

Purposes: To clarify the incidence and risk factors of postoperative delirium in patients following pancreatic surgery, and the impact of yokukansan (TJ-54) administered to reduce delirium. Methods: Fifty-nine consecutive patients who underwent pancreatic surgery (2012.4-2013.5) were divided into 2 groups: TJ-54 group: patients who received TJ-54 (n = 21) due to insomnia and the No-TJ-54 group: patients who did not receive TJ-54 (n = 38), and the medical records including the delirium rating scale - Japanese version (DRS-J) were retrospectively reviewed. Results: Postoperative delirium occurred in 2 patients (9.5%) in the TJ-54 group and in 4 (10.5%) patients in the No-TJ-54 group (p = 0.90). The DRS-J on 5 days after surgery was lower in the TJ-54 group than in the No-TJ-54 group (rough p = 0.006), however, without any statistically significant differences with the Bonferroni correction. As for the hospital cost, there was no difference between the TJ-54 and the No-TJ-54 groups (p = 0.78). History of delirium was identified as an independent risk factor of postoperative delirium. Conclusion: The patients with preoperative insomnia, who were treated with TJ-54, did not have a higher incidence of postoperative delirium, compared to those without preoperative insomnia. The patients who had a history of delirium have an increased risk of postoperative delirium and should be cared for and treated prophylactically to prevent it.

A Prospective Randomized Study of the Herbal Medicine Yokukansan for Preventing Delirium After Gastrointestinal Cancer Surgery

“…However, there are few clinical trials about preventive medications for postoperative delirium, and they did not provide sufficient evidence regarding the efficacy of these medications. 2,15,17 The DSM-5 is the standard for the diagnosis of delirium. However, the use of DSM-5 for the evaluation of delirium is highly specialized and requires a psychiatric evaluation.…”

“…Further, there is a high proportion of hospitalized elderly patients with cancer who present with postoperative delirium (10.9%-50%). [1][2][3][4] The condition is believed to be attributed to different perioperative clinical factors associated with cardiac, general, and vascular diseases. [5][6][7] Delirium is a mild to moderate disorder of consciousness with acute onset of cognitive decline, psychiatric symptoms (such as hallucinations, delusions, and agitation), and disorientation.…”

Effectiveness of medicinal herbs on psychological indices before and after surgeries

“…Although, in many reviewed clinical studies, positive outcomes were observed in controlling the psychological symptoms of patients, but in several studies, herbal treatments could not be effective in psychological disorders (47,57,58). Side effects and herb-drug interactions are the most important issue that anaesthetists and surgeons caution during oral administration.…”