Department of Critical Care Medicine Ward III, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 of JingwuWeiqi Street, Huaiyin District, Jinan, 250021, China.
Surg Today. 2023 Jun;53(6):736-742. doi: 10.1007/s00595-022-02614-4. Epub 2022 Nov 5.
Postoperative delirium (POD) commonly occurs after major abdominal surgery and is associated with increased morbidity and mortality. There have been many studies on the relationship between POD and various surgeries, but research on POD after pancreatic cancer surgery is limited. The aim of this study was to identify the incidence and risk factors of POD after pancreatic cancer surgery.
The subjects of this retrospective analysis were 196 patients who were transferred for postoperative care after pancreatic cancer surgery, to a 12-bed critical care medicine ward at Shandong Provincial Hospital, affiliated with Shandong First Medical University, between January 2015 and December 2019. The patients were divided according to whether they suffered POD into a delirium group and a non-delirium group. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit and two independent medical practitioners analyzed all the data. Univariate and multiple logistic regression analyses were performed.
The overall delirium incidence was 20.41%, which increased to 29.03% for patients aged ≥ 70 years. POD was associated with age, smoking, the American Society of Anesthesiologists classification, the Acute Physiology and Chronic Health Evaluation II score, and the TNM stage of the cancer. The variables concerning sex, drinking, hypertension, a history of cerebral disease, surgery type, operation time, amount of bleeding, and the intraoperative use of dexmedetomidine did not differ significantly between the two groups. There was no significant difference in the length of ICU stay, with the exclusion of long-term stay for complications, between the groups, but POD tended to prolong the postoperative hospital stay and increase the risk of mortality. There was also a gradual decline in the incidence of POD between 2015 and 2019, especially from 2015 to 2018, after preventive measures were implemented.
POD is related to many risk factors and worthy of attention. Appropriate management can reduce its incidence or at least shorten its duration.
术后谵妄（POD）通常发生在大型腹部手术后，与发病率和死亡率增加有关。已经有许多关于 POD 与各种手术之间关系的研究，但关于胰腺癌手术后 POD 的研究有限。本研究旨在确定胰腺癌手术后 POD 的发生率和危险因素。
本回顾性分析的对象是 196 例在山东省立医院 12 张重症监护医学病房接受胰腺癌手术后转入术后护理的患者，该医院隶属于山东第一医科大学。患者根据是否患有 POD 分为谵妄组和非谵妄组。使用重症监护谵妄评估方法（CAM-ICU）和两名独立的医务人员对谵妄进行评估，并对所有数据进行单因素和多因素逻辑回归分析。
总体谵妄发生率为 20.41%，年龄≥70 岁的患者发生率为 29.03%。POD 与年龄、吸烟、美国麻醉师协会分类、急性生理学和慢性健康评估 II 评分以及癌症的 TNM 分期有关。性别、饮酒、高血压、脑部疾病史、手术类型、手术时间、出血量以及术中使用右美托咪定等变量在两组间无显著差异。两组 ICU 住院时间无显著差异，但排除并发症后长期住院时间，POD 倾向于延长术后住院时间并增加死亡率。此外，在实施预防措施后，2015 年至 2019 年期间，POD 的发生率逐渐下降，尤其是 2015 年至 2018 年期间。
POD 与许多危险因素有关，值得关注。适当的管理可以降低其发生率，或至少缩短其持续时间。
