Investigative and Clinical Urology

The Korean Urological Association (대한비뇨의학회)
권호 표지

The Risk Factor of Delirium after Transurethral Resection of the Prostate

경요도전립선절제술 후 발생한 섬망의 위험인자

Jung, Sung-Won;Park, Seung-Chol;Rim, Joung-Sik
정성원;박승철;임정식

  • Published : 20060900
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Abstract

Purpose: Transurethral resection of the prostate(TURP) is the surgical treatment for symptomatic benign prostate hyperplasia with a good result, but some cases of postoperative delirium have been associated with this treatment. The purpose of this study is to develop and validate clinical prediction of postoperative delirium using the preoperative and postoperative data. Materials and Methods: We analyzed 417 patients who were admitted for TURP between January 1999 and December 2004. All patients underwent evaluations, including a medical history and laboratory tests, and we recorded the operative time, resection volume, complications, medications and length of stay from the medical records. Postoperative delirium was diagnosed using DMS-IV. Logistic regression test was used to assess the data of the patients and to determine the risk factor of postoperative delirium. Results: Postoperative delirium occurred in 33 patients(7.9%) of the 417 patients. The hospital stay of the patients with delirium was longer than that of the patients without delirium. Delirium was associated with an age$\geq$70 years, a postoperative Hb＜10g/dl and decreased Hb$\geq$2.0g/dl(p＜0.05). A postoperative Hb＜10g/dl and a decreased Hb$\geq$2.0g/dl were associated with an increased risk of delirium on the multivariate analysis (odds ratio=4.6 and 5.7). Conclusions: The incidence of postoperaitve delirium in elderly patients with symptomatic benign prostate hyperplasia was 7.9%, and a postoperative Hb＜10g/dl and a decreased Hb$\geq$2.0g/dl were identified as risk factors. Because delirium was associated with a variety of adverse outcomes, difficult treatment and high mortality, those patients with risk factor for delirium must be kept under close observation after TURP.

Keywords

References

  1. Glynn RJ, Campion EW, Bouchard GR, Silbert JE. The development of benign prostatic hyperplasia among volunteers in the Normative Aging Study. Am J Epidemiol 1985;121:78-90
  2. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol 1984;132:474-9 https://doi.org/10.1016/S0022-5347(17)49698-4
  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington DC: American Psychiatric Association; 1997;123-33
  4. Nadelson T. The psychiatrist in the surgical intensive-care unit. I. Postoperative delirium. Arch Surg 1976;111:113-7 https://doi.org/10.1001/archsurg.1976.01360200019002
  5. Bowman AM. The relationship of anxiety to development of postoperative delirium. J Gerontol Nurs 1992;18:24-30
  6. Rudberg MA, Pompei P, Foreman MD, Ross RE, Cassel CK. The natural history of delirium in older hospitalized patients: a syndrome of heterogeneity. Age Ageing 1997;26:169-74 https://doi.org/10.1093/ageing/26.3.169
  7. Williams-Russo P, Urquhart BL, Sharrock NE, Charlson ME. Post-operative delirium: predictors and prognosis in elderly orthopedic patients. J Am Geriatr Soc 1992;40:759-67 https://doi.org/10.1111/j.1532-5415.1992.tb01846.x
  8. Dyer CB, Ashton CM, Teasdale TA. Postoperative delirium. A review of 80 primary data-collection studies. Arch Intern Med 1995;155:461-5 https://doi.org/10.1001/archinte.155.5.461
  9. Kaneko T, Takahashi S, Naka T, Hirooka Y, Inoue Y, Kaibara N. Postoperative delirium following gastrointestinal surgery in elderly patients. Surg Today 1997;27:107-11 https://doi.org/10.1007/BF02385897
  10. Jung SY, Choi HC, Choi SH. Clinical characteristics of postoperative delirium after urological surgery. Korean J Urol 2001;42:218-22
  11. Rockwood K. The occurrence and duration of symptoms in elderly patients with delirium. J Gerontol 1993;48:M162-6 https://doi.org/10.1093/geronj/48.4.M162
  12. Inouye S, Bogardus ST, Charpenter PA, Leo-Summers L, Acampora D, Holford TR, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999;340:669-76 https://doi.org/10.1056/NEJM199903043400901
  13. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA 1996;275:852-7 https://doi.org/10.1001/jama.275.11.852
  14. Sasajima Y, Sasajima T, Uchida H, Kawai S, Haga M, Akasaka N, et al. Postoperative delirium in patients with chronic lower limb ischaemia: what are the specific markers? Eur J Vasc Endovasc Surg 2000;20:132-7 https://doi.org/10.1053/ejvs.2000.1130
  15. Bohner H, Hummel TC, Habel U, Miller C, Reinbott S, Yang Q, et al. Predicting delirium after vascular surgery: a model based on pre- and intraoperative data. Ann Surg 2003;238:149-56 https://doi.org/10.1097/00000658-200307000-00019
  16. Herrmann M, Ebert AD, Galazky I, Wunderlich MT, Kunz WS, Huth C. Neurobehavioral outcome prediction after cardiac surgery: role of neurobiochemical markers of damage to neuronal and glial brain tissue. Stroke 2000;31:645-50 https://doi.org/10.1161/01.STR.31.3.645
  17. Elie M, Cole MG, Primeau FJ, Bellavance F. Delirium risk factors in elderly hospitalized patients. J Gen Intern Med 1998;13:204-12 https://doi.org/10.1046/j.1525-1497.1998.00047.x
  18. Marcantonio ER, Juarez G, Goldman L, Mangione CM, Ludwig LE, Lind L, et al. The relationship of postoperative delirium with psychoactive medications. JAMA 1994;272:1518-22 https://doi.org/10.1001/jama.272.19.1518
  19. Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 1994;271:134-9 https://doi.org/10.1001/jama.271.2.134
  20. Gustafson Y, Brannstrom B, Berggren D, Ragnarsson JL, Sigaard J, Bucht G, et al. A geriatric-anaesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures. J Am Geriatr Soc 1991;39:655-62 https://doi.org/10.1111/j.1532-5415.1991.tb03618.x
  21. Martin D. Preoperative visits to reduce patient anxiety: a study. Nurs Stand 1996;10:33-8
  22. Nakamura J, Uchimura N, Yamada S, Nakazawa Y. Does plasma free-3-methoxy-4-hydroxyphenyl (ethylene) glycol increase in the delirious state- A comparison of the effects of mianserin and haloperidol on delirium. Int Clin Psychopharmacol 1997;12:147-52 https://doi.org/10.1097/00004850-199705000-00005
  23. Meagher DJ. Delirium: optimising management. BMJ 2001;322:144-9 https://doi.org/10.1136/bmj.322.7279.144