Clinical Paper
Head and Neck Oncology
Clinical observations of postoperative delirium after surgery for oral carcinoma

https://doi.org/10.1016/j.ijom.2009.01.011Get rights and content

Abstract

The aim of the present study was to clarify the clinical characteristics of postoperative delirium and to determine appropriate postoperative management for its prevention. The authors analysed 132 cases of primary surgery for oral carcinoma and observed 24 (18%) cases of postoperative delirium. Univariate analysis revealed that significant risk factors for postoperative delirium were older age, male gender, extensive surgery and morphine pain control. Logistic regression analysis showed that older age and male gender were significant risk factors for postoperative delirium, while patient-controlled analgesia with fentanyl was effective for prevention of postoperative delirium. There was a trend for postoperative delirium to be associated with extensive surgery. In those who had delirium, blood tests revealed that alkaline phosphatase, total protein, sodium, chlorine, red blood cell count, haemoglobin and haematocrit were significantly diminished after surgery. These results indicate that general condition is closely related to the onset of postoperative delirium, and suggest that appropriate postoperative management can reduce the incidence of this complication.

Section snippets

Subjects

The authors retrospectively analysed 132 cases of oral carcinoma. All patients underwent primary surgery under general anaesthesia between January 2001 and September 2006.

Patients were diagnosed with postoperative delirium when symptoms corresponded to one of the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) definition2: disturbance of consciousness (i.e. reduced clarity of awareness of the environment) with reduced ability to focus,

Incidence of postoperative delirium

A total of 132 patients who underwent primary surgery for oral carcinoma were studied. Patient profiles are summarised in Table 1 and no significant gender-related differences were observed. Postoperative delirium occurred in 24 (18%) of 132 patients.

Risk factors revealed by univariate analyses

Univariate analyses revealed that older age (Student's t-test; p = 0.0023), male gender (Fisher's exact test; p = 0.0237), more extensive surgical procedure (Fisher's exact test; p = 0.0072) and postoperative pain control with morphine (Fisher's exact

Discussion

The incidence of postoperative delirium was 18% in the present study; this is similar to previous reports describing an incidence of 17–26% in patients undergoing resections of malignant head and neck tumours7, 14, 16. The present study showed a significant gender-related difference in the incidence of postoperative delirium, whereas previous studies have shown only a trend in this direction. No reports have shown female gender to be a risk factor for postoperative delirium, so it is reasonable

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