Hydroxyethyl starch is associated with early postoperative delirium in patients undergoing esophagectomy

Postoperative delirium is associated with longer hospital stay and increased morbidities. Patients undergoing esophagectomy have a high chance of developing postoperative delirium because of their advanced age, comorbidities, and intensive care unit care. In this study, we investigated the risk factors of early postoperative delirium in patients undergoing esophagectomy, focusing on perioperative fluid type to test the hypothesis that colloids with high oncotic pressure and anti-inflammatory action would decrease the incidence of postoperative delirium compared with crystalloids.

All patients who underwent esophagectomy from 2010 to 2015 in a tertiary care center were reviewed in this retrospective study (n = 1041). Patients who showed positive Confusion Assessment Method or received haloperidol within 4 days postoperatively were enrolled as those with postoperative delirium (+). Multivariable logistic regression was performed to identify risk factors for postoperative delirium. Incidence of postoperative delirium was compared among crystalloids, hydroxyethyl starch, and albumin groups after propensity score matching.

The incidence of delirium within postoperative 4 days was 22.7%. Infusion of hydroxyethyl starch was an independent risk factor (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.09-2.14; P = .0151). Other risk factors were age (OR, 1.04; 1.02-1.06, per year; P = .0002), preoperative cerebrovascular disease (OR, 2.18; 1.15-4.12; P = .0170), pulmonary dysfunction (OR, 1.85; 1.33-2.58; P = .0003), and transfusion (OR, 1.76; 1.22-2.53; P = .0023). Propensity score matching analysis confirmed that administration of hydroxyethyl starch, but not albumin, is related to postoperative delirium.

Old age, preoperative cerebrovascular disease, pulmonary dysfunction, transfusion, and hydroxyethyl starch administration were related to early postoperative delirium. If colloid must be administered, albumin is preferred to hydroxyethyl starch.