Incidence and risk factors of subsyndromal delirium after curative resection of gastric cancer

Heesung Hwang,Hyuk-Joon Lee,Won-Hyoung Kim,Yun-Suhk Suh,Kyung-Lak Son,Joo-Young Lee,Bong-Jin Hahm,Dooyoung Jung,Kwang-Min Lee,Seong-Ho Kong,Han-Kwang Yang

doi:10.1186/s12885-018-4681-2

Abstract

BackgroundSubsyndromal delirium, a condition in which patients exhibit some, but not all, of the symptoms of delirium, can negatively affect the outcomes of patients with cancer. However, the incidence of subsyndromal delirium in patients with gastric cancer is unknown. Here, we investigated the incidence and risk factors of subsyndromal delirium after curative resection of gastric cancer.MethodsWe recruited consecutive patients with gastric cancer who were scheduled for curative resection at a tertiary hospital. Patients’ subsyndromal delirium symptoms were serially assessed preoperatively and 1, 2, 3, and 7 days postoperatively using the Delirium Rating Scale-Revised-98 (DRS-R-98). A DRS-R-98 score of 8–14 at any postoperative assessment was considered to indicate subsyndromal delirium. Sociodemographic and pre−/intra-operative clinical data were also assessed. Logistic regression analyses were used to determine the associated risk factors.ResultsData were analysed from 163 out of 217 eligible patients. Postoperative delirium occurred in one patient (0.6%) and subsyndromal delirium occurred in 19 patients (11.7%). Age ≥ 70 years (odds ratio, [OR] 3.85; 95% confidence interval [CI], 1.36–10.92; p = 0.011) and education level ≤ 9 years (OR, 3.98; 95% CI, 1.39–11.41; p = 0.010) were independent risk factors of subsyndromal delirium after adjusting for preoperative cognitive function. Other pre−/intra-operative variables including anxiety/depression, poor sleep quality, and anaesthesia duration were not associated with subsyndromal delirium.ConclusionsIn contrast to the low incidence of delirium among patients undergoing curative resection of gastric cancer, a substantial proportion of such patients experienced subsyndromal delirium. Considering the prognostic implications, more careful detection and management of subsyndromal delirium may be warranted in patients with gastric cancer.

Highlights

Subsyndromal delirium, a condition in which patients exhibit some, but not all, of the symptoms of delirium, can negatively affect the outcomes of patients with cancer
Incidence of delirium and subsyndromal delirium During the study period, 217 patients were admitted for surgery
The DRS-R-98 scores of these patients did not increase after surgery; they were not considered to have postoperative subsyndromal delirium and were considered to be part of the group with no delirium

Summary

Introduction

Subsyndromal delirium, a condition in which patients exhibit some, but not all, of the symptoms of delirium, can negatively affect the outcomes of patients with cancer. The incidence of subsyndromal delirium in patients with gastric cancer is unknown. We investigated the incidence and risk factors of subsyndromal delirium after curative resection of gastric cancer. Patients with subsyndromal delirium display only a few delirium symptoms (e.g., inattention, thought disturbances, increased vigilance, irritability, anxiety, restlessness, and/or sleep disturbances) without meeting the full criteria of delirium [12, 13]. Subsyndromal delirium has been of clinical interest since the early twenty-first century, and, like delirium, subsyndromal delirium is associated with negative patient outcomes, such as lengthened hospital stays, worse cognitive and functional outcomes, and higher mortality rates [14,15,16,17,18]. As subsyndromal delirium may be a marker of underlying medical conditions that are not severe enough to cause full delirium [13], it could be considered that risk factors of subsyndromal delirium could be intrinsic factors in those of delirium

Methods

Results

Discussion

Conclusion