2005 Abstracts: Postoperative Delirium in Elderly Patients with Gastrointestinal Malignancies
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Postoperative Delirium in Elderly Patients with Gastrointestinal Malignancies
Yuichi Kitagawa, Shinji Fukata, Department of Surgery, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; Akihiro Yasui, Department of Surgery, Aichi Saiseikai Hospital, Nagoya, Aichi, Japan
Purpose: Postoperative delirium is one of the most considerable complications for elderly surgical patients in mature society.
Methods: 442 patients with the age over 80 were retrospectively examined as a part of gcooperative longevity studyh supported by Japanese Ministry of Health, Labor and Welfare. In this multi-institutional series, 239 patients were operated for malignancies of digestive organs. 102 colon cancers, 74 gastric cancers, 42 rectal cancers and 21 other abdominal malignancies were registered with this study. During these patients with malignancy, 52 patients (21.8 %) were diagnosed as having delirium, postoperatively. Results: The age was similar in patients with delirium (83.8 years) and the patients without delirium (83.6 years). As for preoperative complications, the rate of hypertension was higher in patients with delirium (48.1 and 33.2 %, P=0.048). Additionally, the history of cerebrovascular diseases was dominantly found in patients with delirium (26.9 and 13.0 %, P=0.014). The operative time and blood loss showed no significant difference between both groups. Postoperative hospital stay was also similar (31.8 and 35.4 days). The morbidity rate was 48.1 % in the patients with delirium and 32.1 % in the patients without delirium (P=0.033), respectively. Wound infection was most frequent postoperative complications (19.2 and 9.1 %). The rate of wound infection (P=0.041) and bowel obstruction (9.6 and 2.7 %, P=0.027) were statistically higher in patients with delirium. The mortality rate was similar (7.7 % and 3.7 %). In patients with delirium, duration of delirium (median 3 days) had positive correlation between operative blood loss (median 140 gram) (R=0.61) and length of hospital stay (median 22 days) (R=0.67). Conclusions: In aged surgical candidates for malignancy, one fifth of the patients could have postoperative delirium. Hypertension and cerebrovascular diseases were considerable risk of delirium. Delirium had no correlation between other postoperative complications except for wound infection and bowel obstruction. As prolonged the duration of delirium, postoperative hospital stay was extended.
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