Analysis Of Risk Factors For Delirium After Radical Resection Of Head And Neck Malignant Tumors

ObjectiveHead and neck malignant cancer(HNC)is a common type of tumor,and postoperative delirium(POD)is one of the common complications in these patients.Delirium refers to a state of disturbance of consciousness,manifested as loss or disappearance of consciousness of the environment,cognitive dysfunction,behavioral abnormalities and sleep disorders.Delirium has an important impact on the rehabilitation and treatment of patients,which may lead to prolonged hospital stay,increased treatment costs,reduced patient satisfaction and increased mortality.Therefore,to evaluate the risk factors of delirium after radical resection of head and neck malignant tumors,to provide clinicians with better treatment options and clinical management strategies,and to provide a basis for formulating countermeasures for the prevention and treatment of postoperative delirium.MethodsThis study was a retrospective cohort study,which was included in the study from October 1,2018 to October 1,2021.A retrospective study was conducted in the Department of Oral and Maxillofacial Surgery,Xuzhou Center Hospital and Shanghai Jiao Tong University School of Medicine and the Ninth People’s Hospital of Shanghai Jiao Tong University School of Medicine.Patients who were underwent radical surgery for head and neck cancer were included in the study population.In this retrospective observational study,all the necessary data were collected.A total of 516 patients were included,including 328 males and 188 females.Related risk factors and vital signs were reviewed and collected.According to the confusion assessment mother(CAM),the patients were divided into delirium group(65 cases,44 males and 21 females)and non-delirium group(451 cases,284 males and 167 females).Univariate analysis and multivariate logistic regression analysis were used for statistical analysis.ResultsThe incidence of delirium after head and neck cancer surgery was 12.2%(65/516).Single factor analysis between groups in age(Z=4.62,P<0.001),smoking(χ2=5.46,P=0.019),drinking(χ2=5.74,P=0.017),operation time(Z=4.50,P<0.001),tracheotomy(χ2=14.26,P<0.001),intraoperative blood transfusion(χ2=22.87,P<0.001),free flap(χ2=23.65,P<0.001),ICU guardianship time(Z=2.20,P=0.028),and postoperative VAS pain(Z=3.64,P<0.001),sleep disorders(χ2=21.19,P<0.001),postoperative fever(χ2=28.95,P<0.001)showed statistical differences(P<0.05).There was no significant difference in gender,BMI,hypertension,diabetes,heart disease and cerebrovascular disease(P>0.05).In patients with delirium,there were significant differences in reoperation(χ2=42.67,P<0.001)and hospitalization time(Z=3.91,P<0.001).Logistic multivariable analysis showed the risk factors associated with POD included age(OR=1.05,95%CI:1.02-1.08,P<0.001),intraoperative blood transfusion(OR=2.64,95%CI:1.38-5.03,P=0.003),tracheotomy(OR=4.02,95%CI:1.61-10.07,P=0.003),postoperative sleep disorder(OR=6.64,95%CI:3.43-12.84,P<0.001),fever(OR=3.28,95%CI:1.39-7.72,P=0.007),and postoperative pain(OR=1.42,95%CI:1.17-1.71,P<0.001).ConclusionThis study collected cases of patients undergoing radical surgery for head and neck malignant tumors.Studies have shown that age,blood transfusion,tracheotomy,postoperative sleep disorders,fever,and postoperative VAS pain are independent risk factors for postoperative delirium.The operation time,free flap repair,smoking history,history of alcohol abuse,and ICU intensive care time are not independent risk factors for postoperative delirium,but they are statistically significant in the analysis of single factor groups.This shows that these factors can promote the occurrence of postoperative delirium through cross-action.The influence of these factors cannot be ignored in clinical practice.The search for related risk factors has certain clinical guidance for clinical medical staff,and provides a target population for improving the quality of treatment and improving the treatment plan.Early prevention can play a key role.