J. Fanning et al., POSTOPERATIVE DELIRIUM FOLLOWING RADICAL GYNECOLOGIC ONCOLOGY SURGERY, International journal of gynecological cancer, 6(2), 1996, pp. 94-97
The purpose of this study was to determine the incidence and possible
predisposing factors for the development of postoperative delirum foll
owing radical gynecologic oncology surgery. A retrospective chart revi
ew was performed on 153 consecutive patients undergoing radical gyneco
logic oncology surgery. Preoperative variables assessed included: age,
sepsis, decreased vision, decreased hearing, psychiatric history and
abnormal mental status. Operative variables assess included: anesthesi
a time, estimated blood loss, hypotension, arrhythmia and transfusions
. Preoperative medications, postoperative pain medication and abnormal
perioperative laboratory values were also assessed. Sixteen of 150 pa
tients (11%) developed postoperative delirium. Age was a significant p
redictor of postoperative delirium (median age 69 years vs 53 years, P
= 0.006). Preoperative abnormal mental status examination was a signi
ficant predictor (P = 0.27). Use of chronic narcotic pain medication w
as significant (P = 0.008). All three patients who were septic at the
time of emergency surgery developed postoperative delirum (P = 0.001).
No other variables could be identified. When reviewing the date using
any high risk factor as a positive test (advanced age, sepsis, abnorm
al mental status exam or chronic narcotic pain medication), sensitivit
y was 88%, specificity 76%, positive predictive value 35% and negative
predictive value 77%. Delirium occurred most frequently on the second
postoperative day (range 1-4 days) and lasted for a median of 2 days
(range 1-5 days). Delirium resolved completely in all 16 patients. In
conclusion, 11% of women undergoing radical gynecologic oncology surge
ry developed postoperative delirium. Advanced age, preoperative abnorm
al mental status, chronic narcotic pain medication and preoperative se
psis were all predisposing risk factors.