Delirium after emergency surgery in patients with gastrointestinal obstruction or perforation: a retrospective cohort study for 5 years.

BACKGROUND

Postoperative delirium (POD) is a common complication after major surgery, particularly in patients who underwent emergency gastrointestinal (GI) obstruction or perforation surgery. This study aimed to retrospectively assess the incidence and risk factors of POD in this cohort.

METHODS

This study included 583 patients who were diagnosed with GI obstruction or perforation and underwent emergency surgery. POD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria or evaluated using the Confusion Assessment Method for the Intensive Care Unit. The risk factors for delirium were analyzed using univariate and multivariate methods.

RESULTS

Overall, 106 patients (18.2%) developed delirium within the first 7 days after surgery. The analysis revealed the following independent risk factors: age (adjusted odds ratio [aOR], 1.097 [95% CI, 1.065-1.131; P <.001), coronary heart disease (aOR, 3.125 [95% CI, 1.485-6.577; P =.003), hypoproteinemia (aOR, 16.782 [95% CI, 5.484-51.355]; P <.001), septic shock (aOR, 8.565 [95% CI, 4.140-17.721]; P <.001), and intraoperative hypotension (aOR, 4.223 [95% CI, 1.901-9.382]; P <.001). Low-dose dexamethasone (aOR, 0.414 [95% CI, 0.217-0.787]; P =.007) was confirmed as an independent protective factor for POD. The delirium group experienced a significantly longer hospitalization duration, higher 7-day mortality, and increased in-hospital mortality.

CONCLUSION

Our study identified several high-risk factors for POD in patients with acute GI obstruction or perforation conditions. Low-dose dexamethasone may be an independent protective factor.