Imai Takayuki, Takasago Teiko, Nakanome Ayako, Morita Shinkichi, Miyakura Yuya, Sasaki Kento, Ito Kazue, Goto Takahiro, Asada Yukinori
Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi, Japan.
Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi, Japan.
Auris Nasus Larynx. 2024 Dec;51(6):929-932. doi: 10.1016/j.anl.2024.09.001. Epub 2024 Sep 20.
Hyperactive delirium with agitation following head and neck surgeries with free tissue transfer reconstruction (HNS-FTTR) represents a critical and potentially life-threatening postoperative complication. Although preoperative risk assessment is important, no established risk screening tool has been developed to accurately predict its occurrence.
In this retrospective observational study, we examined 192 consecutive patients who underwent HNS-FTTR between August 2019 and January 2024. We assessed the effectiveness of the existing delirium risk screening system, the DELirium Team Approach program which includes factors such as age ≥ 70 years, presence of brain disorders, dementia, alcohol consumption habits, a history of delirium, and use of benzodiazepines. Additionally, we explored the association between each risk factor and the onset of delirium.
Delirium occurred in 43 patients (22.4 %). The risk screening tool effectively predicted the occurrence of hyperactive delirium after HNS-FTTR (OR: 8.316; 95 % CI: 2.205-36.060; p = 0.004), with a sensitivity of 95.3 % and a specificity of 28.9 %. Multivariate analysis revealed age ≥ 70 years (OR: 2.179; 95 % CI: 1.058-4.662; p = 0.0383) and alcohol consumption habits (OR: 2.554; 95 % CI: 1.260-5.268; p = 0.0098) as significant independent risk factors.
Our findings suggest that the risk screening system evaluated in this study appears to be sensitive, simple, and effective for the preoperative prediction of hyperactive postoperative delirium following HNS-FTTR.
头颈部手术游离组织移植重建（HNS-FTTR）后出现的伴有激越的多动性谵妄是一种严重且可能危及生命的术后并发症。尽管术前风险评估很重要，但尚未开发出成熟的风险筛查工具来准确预测其发生。
在这项回顾性观察研究中，我们检查了2019年8月至2024年1月期间连续接受HNS-FTTR的192例患者。我们评估了现有的谵妄风险筛查系统，即谵妄团队方法计划的有效性，该计划包括年龄≥70岁、脑部疾病、痴呆、饮酒习惯、谵妄病史和苯二氮䓬类药物使用等因素。此外，我们探讨了每个风险因素与谵妄发作之间的关联。
43例患者（22.4%）发生谵妄。该风险筛查工具能有效预测HNS-FTTR后多动性谵妄的发生（OR：8.316；95%CI：2.205-36.060；p=0.004），敏感性为95.3%，特异性为28.9%。多因素分析显示年龄≥70岁（OR：2.179；95%CI：1.058-4.662；p=0.0383）和饮酒习惯（OR：2.554；95%CI：1.260-5.268；p=0.0098）是显著的独立风险因素。
我们的研究结果表明，本研究中评估的风险筛查系统对于术前预测HNS-FTTR术后多动性谵妄似乎是敏感、简单且有效的。
