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Mechanical Bowel Preparation Is a Risk Factor for Postoperative Delirium as It Alters the Gut Microbiota Composition:
Zhoujing Yang1, Chuandi Tong1, Xinye Qian1
1Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
Background And Objective:
Postoperative delirium (POD) is a frequent complication in patients undergoing gastrectomy. Increasing evidence suggests that abnormal gut microbiota composition may contribute to its morbidity. However, it is unclear whether mechanical bowel preparation would cause postoperative delirium by altering the gut microbiota of patients. This study aimed to investigate the association between mechanical bowel preparation and postoperative delirium in patients undergoing gastrectomy.
Methods:
A prospective randomized single-center study was performed. A total of 81 patients with gastric cancer were enrolled and randomly assigned to two groups: preparation group and non-preparation group according to whether the patient received MBP before surgery. To diagnose postoperative delirium, we used the 3-Min Diagnostic Interview for Confusion Assessment Method-defined delirium for five successive days after surgery. 16s rRNA gene sequencing was used to investigate changes in the intestinal bacteria. The linear discriminant analysis and effect size (LefSe) analysis were also used to identify the different taxa of fecal microbiota between the postoperative delirium and non-postoperative delirium groups.
Results:
We found that there was a significant difference in β-diversity of the gut microbiota between the preparation group and non-preparation group (P = 0.048). Furthermore, patients in the preparation group had a much higher rate of postoperative delirium (13/40, 32.5%) compared with that in non-preparation groups (4/41, 9.8%). Multivariate regression analysis adjusted by other risk factors indicated that mechanical bowel preparation was associated with the occurrence of delirium (odds ratio = 4.792; 95% confidence interval: 1.274-18.028; P = 0.020). When comparing the gut microbiota of patients with and without POD, Bacteroides and Veillonella (genus), which were higher in the preparation group, were also higher in delirium patients (P < 0.05). Genus Olsenella was both relatively higher in the non-preparation group and non-POD group (P < 0.05).
Conclusion:
Mechanical bowel preparation not only altered the gut microbiota composition of patients with gastric cancer but also increased the incidence of postoperative delirium. Among all the gut microbiota altered by mechanical bowel preparation, Bacteroides and Veillonella genus might be a risk factor of POD. Genus Olsenella might be a beneficial bacteria to reduce the incidence of POD.
Insights
Mechanical bowel preparation significantly increases the risk of postoperative delirium in gastrectomy patients by altering gut microbiota. Specific bacteria like Bacteroides and Veillonella may be risk factors, while Olsenella might be protective.
Area of Science:
- Gastroenterology
- Microbiology
- Geriatric Medicine
Background:
- Postoperative delirium (POD) is a common complication after gastrectomy.
- Gut microbiota alterations are increasingly linked to POD.
- The impact of mechanical bowel preparation (MBP) on POD via gut microbiota changes remains unclear.
Purpose of the Study:
- To investigate the association between mechanical bowel preparation and postoperative delirium in gastrectomy patients.
- To explore the role of gut microbiota alterations in this association.
Main Methods:
- Prospective randomized single-center study involving 81 gastric cancer patients.
- Patients were assigned to MBP or no-MBP groups.
- Postoperative delirium diagnosed using the 3-Min Diagnostic Interview for Confusion Assessment Method; gut microbiota analyzed via 16s rRNA gene sequencing and LefSe analysis.
Main Results:
- MBP significantly altered gut microbiota diversity (β-diversity, P=0.048).
- The MBP group exhibited a higher incidence of POD (32.5%) compared to the no-MBP group (9.8%).
- Multivariate analysis confirmed MBP as an independent risk factor for POD (OR=4.792, P=0.020).
- Bacteroides and Veillonella genera were elevated in both MBP and POD groups, suggesting a potential risk role.
- Olsenella genus was higher in the no-MBP and no-POD groups, indicating a potential protective effect.
Conclusions:
- Mechanical bowel preparation alters gut microbiota composition and increases POD incidence in gastrectomy patients.
- Bacteroides and Veillonella may be risk factors for POD.
- Olsenella may play a protective role against POD.
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