Departments of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan.
General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
J Plast Surg Hand Surg. 2020 Jun;54(3):161-166. doi: 10.1080/2000656X.2020.1724545. Epub 2020 Feb 7.
Postoperative delirium (POD) is a major risk factor for an extended hospital stay and higher costs, and is associated with increased mortality. The incidence of POD is high in free flap procedures, and POD may also be a risk factor for flap loss and complications. Sarcopenia is a condition characterized by skeletal muscle mass (SMM) depletion and a decrease in muscle power or physical activity. The aim of this study was to investigate risk factors for postoperative delirium (POD), including SMM, in 122 patients undergoing free flap repair after oral cancer resection. All patients underwent preoperative abdominal-lumbar CT or PET-CT. Cross-sectional areas (cm) of skeletal muscles at the third lumbar vertebra were measured on preoperative CT, normalized for height, and defined as the skeletal muscle index (SMI, cm/m). Risk factors for POD were investigated, including the value of SMI and taking the type of POD into consideration. POD occurred in 45 patients (36.9%), and was hyperactive in 28 (62.2%), mixed in 13 (28.9%), and hypoactive in 4 (8.9%). In multivariate analysis, high preoperative albumin ( = 0.046, adjusted odds ratio [OR] = 3.69) and postoperative insomnia ( < 0.001, OR = 6.79) were significant risk factors for POD. In a sub-analysis evaluating risk factors restricted to POD including the hypoactive type, lower SMI ( = 0.035, OR = 2.52 per 10-unit decrease) and postoperative insomnia ( = 0.003, OR = 6.37) were significant. We conclude that lower SMM increases the hypoactive and mixed types of POD. Increasing SMM by exercise and nutritional therapy preoperatively may prevent such POD in free flap repair for oral cancer.
术后谵妄（POD）是延长住院时间和增加成本的主要危险因素，并且与死亡率增加有关。游离皮瓣手术后 POD 的发生率很高，POD 也可能是皮瓣丢失和并发症的危险因素。肌肉减少症是一种以骨骼肌质量（SMM）消耗和肌肉力量或体力活动减少为特征的疾病。本研究旨在调查游离皮瓣修复口腔癌切除术后发生术后谵妄（POD）的危险因素，包括 SMM。所有患者均接受术前腹部-腰椎 CT 或 PET-CT 检查。术前 CT 测量第 3 腰椎的骨骼肌横截面积（cm），按身高标准化，并定义为骨骼肌指数（SMI，cm/m）。调查了 POD 的危险因素，包括 SMI 值，并考虑了 POD 的类型。45 例患者（36.9%）发生 POD，其中 28 例（62.2%）为高活动型，13 例（28.9%）为混合型，4 例（8.9%）为低活动型。多变量分析显示，术前白蛋白水平高（=0.046，调整后的优势比[OR] =3.69）和术后失眠（<0.001，OR=6.79）是 POD 的显著危险因素。在一项评估仅限于包括低活动型的 POD 的危险因素的亚分析中，较低的 SMI（=0.035，OR=每降低 10 个单位增加 2.52）和术后失眠（=0.003，OR=6.37）是显著的危险因素。我们得出结论，较低的 SMM 增加了低活动型和混合型 POD 的发生。通过术前运动和营养治疗增加 SMM 可能有助于预防口腔癌游离皮瓣修复后的 POD。
