What factors are associated with the development of postoperative delirium in patients undergoing head and neck free flap reconstruction?
In this cohort study of 515 patients undergoing free flap reconstruction, increased age, male sex, increased operative time, advanced nodal disease, and tobacco use were associated with an increased risk of developing postoperative delirium after head and neck free flap reconstruction. Preoperative alcohol abstinence was identified as a protective factor.
Risk stratification for postoperative delirium provides a tiered framework for quality improvement protocols to reduce the complications and costs associated with postoperative delirium, and preoperative withdrawal from alcohol use may prevent the development of postoperative delirium.
Postoperative delirium (POD) is associated with an increased rate of adverse events, higher health care costs, and longer hospital stays. At present, limited data are available regarding the risk factors for developing POD in patients undergoing head and neck free flap reconstruction. Identification of patients at high risk of developing POD will allow implementation of risk-mitigation strategies.
To determine the frequency of and risk factors associated with POD in patients undergoing free flap reconstruction secondary to head and neck disease.
Design, Setting, and Participants
This retrospective cohort study included 515 patients undergoing free flap reconstruction from January 1, 2006, through December 31, 2012, at the James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Care Center, a tertiary care cancer hospital. Preoperative, intraoperative, and postoperative data were collected retrospectively. Data from January 1, 2006, through December 31, 2012, were analyzed, and the final date of data analysis was January 8, 2018.
Head and neck free flap reconstruction.
Main Outcomes and Measures
The primary outcome was the development of POD as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Univariable and multivariable logistic regression were used to identify risk factors associated with POD.
Five hundred fifteen patients underwent free flap reconstruction during the study period (66.2% male; mean [SD] age, 60.1 [12.8] years). Of these, 56 patients (10.9%) developed POD. On multivariable analysis, risk factors associated with POD included increased age (odds ratio [OR], 1.06; 95% CI, 1.02-1.11), male sex (OR, 5.02; 95% CI, 1.47-17.20), increased operative time (OR for each 1-minute increase, 1.004 [95% CI, 1.001-1.006]; OR for each 1-hour increase, 1.26 [95% CI, 1.08-1.46]), advanced nodal disease (OR, 3.00; 95% CI, 1.39-6.46), and tobacco use (OR, 7.23; 95% CI, 1.43-36.60). Preoperative abstinence from alcohol was identified as a protective factor (OR, 0.24; 95% CI, 0.12-0.51).
Conclusions and Relevance
This study identified variables associated with a higher risk of developing POD. Although many of these risk factors are nonmodifiable, they provide a target population for quality improvement initiatives. Furthermore, preoperative alcohol abstinence may be useful in preventing POD.
Densky J, Eskander A, Kang S, et al. Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction. JAMA Otolaryngol Head Neck Surg. Published online January 03, 2019. doi:10.1001/jamaoto.2018.3820
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