Back to Annual Meeting Program

Background
Delirium is an under-estimated and serious complication following major surgery, particularly in the elderly population. The aim of this study was to identify pre-operative risk factors for delirium following esophagectomy for malignancy, and investigate its impact upon short and long-term outcome.
Methods
All patients undergoing esophagectomy for cancer between 1991 and 2011 had information prospectively entered in an IRB-approved database. Patients were divided into two groups based upon the presence or absence of clinically-significant post-operative delirium, and were compared with respect to use of neoadjuvant therapy, medical co-morbidities, operative outcomes, post-operative complications, overall cost and survival. For the purposes of this study delirium was defined as an acute fluctuating confusional state that required intervention.
Results
500 patients were included in this analysis; 46 (9.2%) patients with post-operative delirium and 454 patients without. Age was significantly increased (71 ± 8.12 yrs vs. 63 ± 10.86 yrs) and BMI was reduced (25 ± 4.24 vs. 27 ± 4.82 kg/m2) in the delirium group. There were no significant differences in cardiac, pulmonary or renal co-morbidities, however ASA grade was significantly increased in the delirium group (2.83 ± 0.44 vs. 2.62 ± 0.54). There were no significant differences between the groups in the use of neoadjuvant therapy.
Analysis demonstrated that delirium was associated with a significantly longer hospital (13.98 ± 7.54 vs. 10.88 ± 5.67 days) and ICU stay (3.59 ± 3.82 vs. 2.68 ± 16.92 days). Furthermore post-operative delirium was associated with a significantly increased incidence of post-operative pneumonia (21.74% vs. 7.93%), pneumothorax (10.87% vs. 2.64%), re-intubation (10.87% vs. 1.76%) and increased overall treatment costs (\ ± 13018 vs. \ ± 9689; P < 0.05).
Age was the only pre-operative predictor of post-operative delirium in multivariate modeling (Odds ratio = 1.08; 95%C.I. = 1.04 - 1.12, P < 0.05). Patients were followed up for an average of approximately 4 years. There was no significant difference between the groups in overall survival (1105 ± 910 days vs. 1273 ± 1428; P = 0.28) and there was no difference in Kaplan Meier curve distribution between the groups.
Conclusion
This study demonstrates that delirium is a risk factor for complicated post-operative recovery and increased treatment costs following esophagectomy, and furthermore that age is independently predictive of its development. Focused screening will allow targeted preventative strategies to be employed in the peri-operative period to reduce complications and cost associated with delirium.