Postoperative delirium following radical gynecologic oncology surgery

The purpose of this study was to determine the incidence and possible predisposing factors for the development of postoperative delirum following radical gynecologic oncology surgery. A retrospective chart review was performed on 153 consecutive patients undergoing radical gynecologic oncology surgery. Preoperative variables assessed included: age, sepsis, decreased vision, decreased hearing, psychiatric history and abnormal mental status. Operative variables assess included: anesthesia time, estimated blood loss, hypotension, arrhythmia and transfusions. Preoperative medications, postoperative pain medication and abnormal perioperative laboratory values were also assessed. Sixteen of 150 patients (11%) developed postoperative delirium. Age was a significant predictor of postoperative delirium (median age 69 years vs 53 years, P = 0.006). Preoperative abnormal mental status examination was a significant predictor (P = 0.27). Use of chronic narcotic pain medication was 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, abnormal mental status exam or chronic narcotic pain medication), sensitivity 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 surgery developed postoperative delirium. Advanced age, preoperative abnormal mental status, chronic narcotic pain medication and preoperative sepsis were all predisposing risk factors.