Incidence and Perioperative Risk Factors for Postoperative Delirium After Major Urological Surgery

Area of Science:

• Geriatric Medicine
• Surgical Complications
• Anesthesiology

Background:

• Postoperative delirium (POD) is a frequent complication in elderly surgical patients.
• Urological surgery in older adults presents a significant risk for POD.
• Identifying perioperative risk factors is crucial for POD prevention.

Purpose of the Study:

• To determine the incidence of POD in male patients aged 50 and above undergoing major urological surgery.
• To investigate perioperative risk factors associated with POD in this cohort.
• To identify independent predictors for POD.

Main Methods:

• Prospective observational study of 162 male patients (≥50 years) undergoing elective major urological surgery.
• Delirium assessment using CAM-ICU twice daily for five postoperative days.
• Multivariate regression analysis to identify independent risk factors for POD.

Main Results:

• 16% of patients developed POD.
• Independent risk factors identified: age ≥ 67.5 years, COPD, mild/moderate alcohol consumption, low preoperative MMSE score (≤25.5), intraoperative hypotension, and severe postoperative pain (NRS ≥ 4.85).
• Older age, comorbidities (especially COPD), rural living, alcohol consumption, intraoperative hypotension, and blood transfusion were associated with higher POD incidence.

Conclusions:

• POD is a significant concern in older men undergoing urological surgery.
• Several modifiable risk factors for POD were identified, suggesting prevention strategies are feasible.
• Prioritizing POD prevention is essential for improving outcomes in elderly surgical patients.