Montreal cognitive assessment domain-specific and clinical predictors of postoperative delirium in elderly gastrointestinal cancer patients.

PURPOSES: Postoperative delirium (POD) is a serious complication in elderly patients undergoing gastrointestinal (GI) cancer surgery. This study aimed to identify the perioperative risk factors for POD, focusing on domain-specific cognitive function.

METHODS

We retrospectively analyzed patients ≥ 65 years old who underwent GI cancer surgery and preoperative geriatric screening. POD was assessed using the Delirium Symptomatology Test. Cognitive domains were evaluated using the Japanese Montreal Cognitive Assessment (MoCA-J). A receiver operating characteristic (ROC) analysis identified the most predictive domain combination and compared its discriminative performance with that of conventional tools. Independent associations with POD were examined using Firth's logistic regression.

RESULTS

Of 167 patients, 13 (7.8%) developed POD. The MoCA-J Memory + Orientation composite score showed the highest predictive accuracy. In the multivariable analysis, a composite score < 7 (odds ratio [OR] = 12.81, 95% confidence interval [CI]: 1.95-84.0), older age (per year, OR = 1.10, 95% CI: 1.01-1.21), preexisting respiratory disease (OR = 7.82, 95% CI: 1.40-43.9), and intraoperative blood loss (per 100 ml increment, OR = 1.53, 95% CI: 1.05-2.25) were independently associated with POD.

CONCLUSIONS

The MoCA-J domain-specific composite score for memory and orientation was the strongest predictor of POD, alongside established factors, such as older age, preexisting respiratory disease, and intraoperative blood loss.