Risk Factors and Incidence of Postoperative Delirium in Patients Undergoing Laryngectomy
Yiru Wang, MD, Huiqian Yu, MD, Hui Qiao, MD, Chan Li, MD, Kaizheng Chen, MD, Xia Shen, MD
https://doi.org/10.1177/0194599819864304 | First Published July 23, 2019
Abstract
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Objective
To explore the risk factors and incidence of postoperative delirium (POD) in patients undergoing laryngectomy for laryngeal cancer.

Study Design
Prospective cohort study.

Setting
Shanghai Eye, Ear, Nose, and Throat Hospital, Fudan University.

Subjects and Methods
A total of 323 patients underwent laryngectomy from April 4, 2018, to December 28, 2018. Perioperative data were collected. The primary outcome was the presence of POD as defined by the Confusion Assessment Method diagnostic algorithm. Univariate and multivariable logistic regression analyses were used to identify risk factors associated with POD.

Results
Of the patients who underwent laryngectomy during the study period, 99.1% were male, with a mean age of 60.0 years. Of these patients, 28 developed POD, with most episodes (88.1%) occurring during the first 3 postoperative days. The type of POD was hyperactive in 7 cases and hypoactive in 21 cases. The mean duration of POD was 1 day. The mean Delirium Rating Scale-Revised-98 score (a measure of POD severity) was 11.5. For the multivariable analysis, risk factors associated with POD included advanced cancer stage, lower educational level, higher American Society of Anesthesiologists classification, and intraoperative hypotension lasting at least 30 minutes. Intraoperative dexmedetomidine use was protective against POD.

Conclusion
This study identified risk factors associated with POD, providing a target population for quality improvement initiatives. Furthermore, intraoperative dexmedetomidine use can reduce POD.