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

Abstract

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.

Spectral Entropy Monitoring Accelerates the Emergence from Sevoflurane Anesthesia in Thoracic Surgery: A Randomized Controlled Trial

“…The incidence of delirium after thoracic surgery was reported to range from 5.3% to 6.7%, which was lower compared to that of our study [ 25 , 26 ]. This might be due to the retrospective nature of prior studies [ 25 , 26 ].…”

Delirium In ICU Patients With Malignancy: Patient Characteristics, Resource Utilization and Outcomes

“…Hepatic and colorectal as well as lung cancer patients often developed delirium while delirium was less frequent in brain cancer patients. Studies on general ward and ICU patients who had undergone oncological surgery reported the following delirium frequencies: 7% for primary pulmonary malignancy [26], 8% for hepatocellular carcinoma [27], 7% for glioblastoma [28] and 14% for colorectal carcinoma [29]. Due to the exclusive inclusion of ICU patients, delirium was more frequent in the present study.…”

“…Comparing oncological patients with and without delirium, sepsis occurred in 26/176 (15%) and 6/312 (1.9%) patients (p < 0.001), while shock was diagnosed in 30/176 (6.1%) and 6/312 (1.9%) patients, respectively (p < 0.001). The SAPS II in delirious and non-delirious patients with malignancy was 41 (27-68) and 24 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), respectively (p < 0.001).…”

Cardiac Delirium Index for Predicting the Occurrence of Postoperative Delirium in Adult Patients After Coronary Artery Bypass Grafting

“…In this case, it was also proven that despite the low frequency of delirium (6.7%), it significantly worsened the prognosis and overall survival. 32 Due to the presence of a factor specific to lung cancer surgery as one of the parameters, it is not possible to use it in other surgical fields.…”