Postoperative delirium in elderly patients after thoracic surgery

Abstract

Background. Postoperative delirium is one of the most severe and common complications of thoracic surgery in elderly patients.Objective. To establish a simple and accurate method for predicting the development of postoperative delirium in patients after thoracic surgery.Material and Methods. We performed an observational cohort study of 303 patients who underwent lobectomy for oncological diseases. The nature of anesthesia and surgical intervention, features of the volume status and hemodynamic changes during the perioperative period were analyzed, laboratory indicators of this period were evaluated.Results. Of 303 patients, 43 (14.2%) developed postoperative delirium. Non-modifiable factors for the development of postoperative delirium included age, history of cerebrovascular accident, alcohol misuse disorder, chronic heart failure, more severe physical status according to the ASA (American Society of Anesthesiologists) Physical Status Classification System. Modifiable factors are the following: the duration of one-lung ventilation, episodes of perioperative hypotension and hypoxemia, the use of opioids, the intensity of the pain syndrome in the postoperative period, and reduced oxygen transport function of the blood. A number of laboratory parameters (blood albumin, blood glucose, leukocytosis), reflecting the degree of surgical stress, may also be useful in postoperative delirium predicting.Conclusion. A prognostic coefficient was compiled with a concordance of 99.9 and Somers' D 0.998. It is equal to the sum of the products: (–3.5367) multiplied by pain intensity on a 10 cm Visual Analogue Scale an hour after surgery; 2.2037 multiplied by the blood albumin level the morning after surgery; (–4.8151) multiplied by the blood glucose level the morning after surgery.

Keywords

• postoperative delirium
• one-lung ventilation
• hypoxemia
• pain syndrome
• hypoalbuminemia
• hyperglycemia