Postoperative Delirium after Reconstructive Surgery in the Head and Neck Region

Abstract

Postoperative delirium (POD) is an acute and serious complication following extended surgery. The aim of this study was to identify possible risk factors and scores associated with POD in patients undergoing reconstructive head and neck surgery. A collective of 225 patients was retrospectively evaluated after receiving reconstructive surgery in the head and neck region, between 2013 to 2018. The incidence of POD was examined with regards to distinct patient-specific clinical as well as perioperative parameters. Uni- and multivariate statistics were performed for data analysis. POD occurred in 49 patients (21.8%) and was strongly associated with an increased age-adjusted Charlson Comorbidity Index (ACCI) and a prolonged stay in the ICU (p = 0.009 and p = 0.000, respectively). Analogous, binary logistic regression analysis revealed time in the ICU (p < 0.001), an increased ACCI (p = 0.022) and a Nutritional Risk Screening (NRS) score ≠ 0 (p = 0.005) as significant predictors for a diagnosis of POD. In contrast, the extent of reconstructive surgery in terms of parameters such as type of transplant or duration of surgery did not correlate with the occurrence of POD. The extension of reconstructive interventions in the head and neck region is not decisive for the development of postoperative delirium, whereas patient-specific parameters such as age and comorbidities, as well as nutritional parameters, represent predictors of POD occurrence.

Incidence and risk factors for postoperative delirium after head and neck cancer surgery: an updated meta-analysis

“…Of these 16 observational studies included, 1 was a case-control study, 14 were retrospective cohort studies, and 1 was a prospective cohort study. Of the 16 articles, 12 studies were conducted in Asia (7 in Japan [ 12 , 18 – 23 ], 3 in China [ 24 – 26 ], and 2 in South Korea [ 27 , 28 ]), while 3 studies were performed in the Germany [ 5 , 15 , 29 ] and the remaining 1 study was conducted in the United States [ 30 ]. The most common diagnostic method was the DSM-IV in 8 of 16 included studies [ 12 , 18 , 19 , 21 , 22 , 24 , 27 , 30 ], the DSM-V in 4 studies [ 5 , 15 , 20 , 29 ], the CAM in 2 studies [ 25 , 26 ], and the ICDSC [ 23 ] and Nu-DESC [ 29 ] in the remaining 2 studies.…”

“…In regard to patients undergoing head and neck cancer surgery, there may be different risk factors for POD. Risk factors for POD after head and neck cancer surgery were reported in the individual studies, but the results were inconsistent or even conflicting [ 12 , 15 ]. Additionally, in 2017, Zhu et al identified several potential risk factors for POD after head and neck cancer surgery using univariate analysis [ 6 ].…”

Elective Tracheotomy in Patients Receiving Mandibular Reconstructions: Reduced Postoperative Ventilation Time and Lower Incidence of Hospital-Acquired Pneumonia

“…A recent multicenter study by Gazda et al associated early tracheotomy with lower odds of postoperative delirium [41]. While age seems to be a prominent risk factor for delirium, elective tracheotomy shortens the hospitalization on intensive care unit and shortens ventilation times, which in turn reduces the risk for delirium [3,42].…”