Analysis And Investigation Of Morbidity Of Postoperative Delirium In Elderly Patients With Gastrointestinal Surgery

BackgroundPostoperative delirium is recognized as one of the most common surgical complications in older adults.It is a set of performance for acute,transient,generalized cognitive impairment-especially in the disturbance of consciousness as the main characteristics of disease states.Postoperative delirium can initiate a cascade of deleterious clinical events,including other major postoperative complications,prolonged hospitalization,loss of functional independence,reduced cognitive function,and death.In view of the complex multifactorial causation of delirium,each individual episode probably has a unique set of component contributors;each set represents a discrete yet sufficient causal mechanism.Accumulating evidence suggests that several different sets of interacting biological factors result in disruption of large-scale neuronal networks in the brain,leading to acute cognitive dysfunction.There are different morbidity of postoperative delirium were reported currently-about 5% to 5%.The morbidity of postoperative delirium also has a certain relation with the operation type.There has a high morbidity of delirium after gastrointestinal surgery for gastrointestinal surgeons.Thus it is necessary to predict and investigate the morbidity of postoperative delirium.Therefore,to investigate and analyze the morbidity,etiological and impact of adverse outcomes of elder patients after gastrointestinal surgery has an important clinical significance for gastrointestinal surgeons.ObjectiveTo conducted a morbidity study,onset time and duration of postoperative delirium in elderly patients after gastrointestinal surgery and analyze the perioperative risk factors of postoperative delirium after gastrointestinal surgery and the impact of adverse outcomes including other major postoperative complications,prolonged hospitalization,rising of turn the ICU rate and death.Methods1.Research objectWe investigate 142 elderly patients(?60 years)after gastrointestinal surgery from2014.10 to 2015.10 in department of gastrointestinal surgery of the people's hospital of Liaocheng city.2.Inclusion criteria(1)Elective surgery patients: gastrointestinal tumor patients: all selected gastrointestinal tumor patients have an endoscope examination(electronic gastroscope or electronic colonoscopy,colonoscopy and sigmoidoscopy)in the endoscopy room of our hospital,or been confirmed by pathology in the pathology department of our hospital.(2)Emergency operation: the patients who need emergency surgery after invalid conservative treatment according to the medical history and CT examination confirmed that trauma,perforation,intestinal necrosis,intestinal obstruction and so on.3.Exclusion criteria(1)Preoperative with conscious barriers and cognitive impairment(2)Delirium history(3)Serious cardiovascular illness(4)Dementia and mental illness(5)Neurosurgical disease surgery history(6)No general anesthesia surgery patients(7)Hospitalization less than four days(8)Age 60 years or less.4.Experimental methodThe levels of serum CRP,IL-6TNF-?,blood biochemical and ASA classification were detected on the day before the operation.The Confusion Assessment Method(CAM)and Delirium Rating Scale Revised 98(DRS-R98)scores methods were used to assess and screening the postoperative delirium.Recording the postoperative VAS score,assessing the morbidity of other major postoperative complications.The levels of serum CRP,IL-6,TNF-?were detected on the day before the operation,the first and the seventh day after operation.Recording and analysising the perioperative risk factors of postoperative delirium.5.Statistical analysisAll quantitative data and all qualitative data were analyzed using Student's t test,Chi-square test and Logistic multivariate regression model respectively with SPSS 19.0with P<0.05 as the statistically significant difference.Results1.In total 142 patients,delirium was diagnosed in 36 patients(25.4%),deliriumdeveloped in 4,7,17,7,1 patients in postoperative day1,2,3,4-7,7+ respectively.There are19 excited type of delirium patients,8 depressive type of delirium patients and 7 mixed type of delirium patients.In total 36 delirium patients,19 ones were recovery in 3 days,10 ones were recovery in 4-7 days,4 ones were recovery in more than 7 days,3 ones caused auto-discharge with delirium.2.There are no statistic difference in the levels of serum CRP,IL-6,TNF-?,blood biochemical of the day before the operation to all of the patients with or without delirium.There are significant statistic difference in the levels of serum CRP,IL-6 after operation and the levels of serum TNF-?were on the contrary.3.No one dead in the hospital.Follow-up 6 months after discharge,2/106 dead for no-delirium patients and 4/36 dead for delirium patients.The length of stay of patients with delirium were longer than the patients without delirium.The morbidity of other major postoperative complications,prolonged hospitalization,and turn to the ICU rate were significantly increased.There are no significant statistic difference in the constituent ratio of four major postoperative complications after Gastrointestinal surgery.One-way test of the eight perioperative risk factors shows that ASA classification?3,Preoperative diabetes mellitus,operating time?3h,blood loss of the operation?20% blood volume,postoperative VAS score,postoperative hypoxemia were significant different but somnipathy and electrolyte disorders were on the contrary.The Logistic multivariate regression model shows that the ASA classification?3,postoperative VAS score,preoperative diabetes mellitus,operating time?3h,postoperative hypoxemia were the independent risk factors for delirium occurrence.Conclusions1.Postoperative delirium is recognized as one of the most common surgical complications in elderly patients with gastrointestinal surgery because it can initiate other major postoperative complications,prolonged hospitalization,heavier economic burden,death and so on.2.The gastrointestinal surgeons should pay close attention to the patient's mental state in postoperative 7 days—especially 3 days and take the interventions in time.3.The increasing levels of serum IL6 and CRP may be associated with the occurrence of postoperative delirium.4.We should focus on the prevention and intervention of perioperative risk factors of gastrointestinal surgey to prevent the occurrence of delirium.