Incidence and factors associated with postoperative delirium in patients undergoing transurethral resection of bladder tumor

Masahiko Kawaguchi,Xiaoying Wang,Mitsuru Ida,Yusuke Naito,Shohei Nakatani

doi:10.1186/s40981-022-00497-5

Masahiko Kawaguchi, Xiaoying Wang

Open Access

https://doi.org/10.1186/s40981-022-00497-5

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Journal: JA Clinical Reports	Publication Date: Jan 22, 2022
Citations: 1	License type: open-access

Affiliation: Nara Medical University

Abstract

BackgroundPostoperative delirium is an important complication after surgery, including urological surgery. This study evaluated the incidence of postoperative delirium and its associated factors after transurethral resection of bladder tumor in adult patients.MethodsPatients aged ≥20 years who underwent elective transurethral resection of bladder tumor under general anesthesia from April 2016 to November 2020 were included. Patient demographic and intraoperative data, including the administration of 5-aminolevulinic acid and hypotension, defined as a mean arterial pressure value < 60 mmHg, were evaluated. The primary outcome was the incidence of postoperative delirium assessed using a chart-based method. The factors associated with postoperative delirium were explored using multiple logistic regression analysis. Postoperative lengths of stay between patients with and without postoperative delirium were compared using the Mann–Whitney U-test.ResultsOf 324 eligible patients with a median age of 76, 26 patients experienced postoperative delirium, with an incidence rate of 8.0% (95% confidence interval, 5.06–10.9). Age (odds ratio 1.13, 95% confidence interval 1.05–1.22, p = 0.001) and body mass index (odds ratio 0.83, 95% confidence interval 0.71–0.97, p = 0.02) were associated with postoperative delirium. Postoperative length of stay between patients with or without postoperative delirium was not significantly different (6 vs 6 days, p = 0.18).ConclusionsThe incidence of postoperative delirium after transurethral resection of bladder tumor under general anesthesia in this study was 8.0%. Older age and low body mass index were associated with development of postoperative delirium.

Highlights

Postoperative delirium is an important complication after surgery, including urological surgery
Transurethral resection of bladder tumor (TUR-BT) using 5-aminolevulinic acid (5-ALA) has become a common procedure to facilitate the identification of an accurate resection range and this is associated with a risk of intraoperative hypotension [8]
Patients who experienced Postoperative delirium (POD) were older; there were no differences in the rate of preoperative 5-ALA administration and intraoperative hypotension between patients who did and did not experience POD

Summary

Introduction

Postoperative delirium is an important complication after surgery, including urological surgery. This study evaluated the incidence of postoperative delirium and its associated factors after transurethral resection of bladder tumor in adult patients. The incidence of POD ranges from 3.4 to 46% depending on the surgical technique and assessment method [3,4,5,6], and some factors, including older age and longer duration of surgery, are associated with POD [3, 5, 7]. Nakatani et al JA Clinical Reports (2022) 8:6 major urological procedures such as radical cystectomy and nephrectomy These advantages are the reasons why older patients are more likely to undergo TUR-BT; because advanced age is a risk factor for POD, the incidence of POD after TUR-BT may be higher than expected. TUR-BT using 5-aminolevulinic acid (5-ALA) has become a common procedure to facilitate the identification of an accurate resection range and this is associated with a risk of intraoperative hypotension [8]

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Results

Conclusion