Occurrence of hyperactive postoperative delirium (POD) with agitation after head and neck surgery with free tissue transfer reconstruction (HNS-FTTR) is associated with the risk of life-threatening complications. The relationships between occurrence of hyperactive POD after HNS-FTTR and inflammatory markers reflecting the surgical stress response, represented by postoperative interleukin-6 levels, are not fully understood.
A retrospective study was conducted on 221 consecutive patients who underwent HNS-FTTR at our department between September 2016 and December 2021. Potential risk factors for POD were examined, including age, operation time, intraoperative blood loss, and postoperative serum levels of blood parameters such as interleukin-6, C-reactive protein, and neutrophil-to-lymphocyte ratio.
Hyperactive POD with agitation was observed in 54 subjects (24.4%). The postoperative hospital stay in the POD group was significantly longer than that in the non-POD group (median: 32.5 days vs. 28 days; p=0.0129). Multivariate logistic regression analysis identified age (in years) (odds ratio: 1.102; p<0.0001), operation time (min) (odds ratio: 1.004; p=0.0359), and postoperative serum interleukin-6 level (pg/mL) (odds ratio: 1.005; p=0.0384) as significant risk factors for development of POD. In a receiver operating characteristic curve and area under the curve analysis, the cut-off value for postoperative serum interleukin-6 level to predict POD development was 82.5 pg/mL. The postoperative serum interleukin-6 ≥82.5 pg/mL group developed hyperactive POD with agitation significantly more often than the postoperative serum IL-6 <82.5 pg/mL group (odds ratio: 4.400; p<0.0001). The postoperative serum IL-6 ≥82.5 pg/mL group also had significantly longer postoperative hospital stay (41.58 ± 33.42 days vs. 31.73 ± 22.89 days; p=0.0151), older age (68.60 ± 9.99 years vs. 64.30 ± 12.58 years; p=0.0054), and longer operation time (625.4 ± 114.05 min vs. 575.5 ± 98.73 min; p=0.0009) than the postoperative serum IL-6 <82.5 pg/mL group.
Postoperative serum interleukin-6 level, as well as age and operation time, were identified as significant independent risk factors for development of hyperactive POD with agitation after HNS-FTTR. Inflammation is a potential target for the prevention and treatment of POD after HNS-FTTR.
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- Delirium.Nat Rev Dis Primers. 2020; 6: 90
- Preoperative identification of patients at risk for delirium after major head and neck cancer surgery.Laryngoscope. 1995; 105: 1066-1068
- Risk factors for postoperative delirium in patients undergoing head and neck cancer surgery.Int J Oral Maxillofac Surg. 2005; 34: 33-36
- Risk factors for postoperative delirium in patients undergoing major head and neck cancer surgery: a meta-analysis.Jpn J Clin Oncol. 2017; 47: 505-511
- Delirium in elderly adults: diagnosis, prevention and treatment.Nat Rev Neurol. 2009; 5: 210-220
- Postoperative delirium in the elderly: diagnosis and management.Clin Interv Aging. 2008; 3: 351-355
- High serum interleukin-6 level is associated with increased risk of delirium in elderly patients after noncardiac surgery: a prospective cohort study.Chin Med J (Engl). 2013; 126: 3621-3627
- Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium among acute type a aortic dissection patients treated with open surgical repair.J Cardiothorac Surg. 2021; 16: 146
- Incidence and risk factors for postoperative delirium after major head and neck cancer surgery.J Craniomaxillofac Surg. 2016; 44: 890-894
- Enhanced recovery after surgery program with dexamethasone administration for major head and neck surgery with free tissue transfer reconstruction: initial institutional experience.Acta Otolaryngol. 2018; 138: 664-669
- Enhanced recovery after surgery program involving preoperative dexamethasone administration for head and neck surgery with free tissue transfer reconstruction: single-center prospective observational study.Surg Oncol. 2020; 34: 197-205
- Effects of dexmedetomidine on postoperative delirium and expression of IL-1beta, IL-6, and TNF-alpha in elderly patients after hip fracture operation.Front Pharmacol. 2020; 11: 678
- The effect of the timing and dose of dexmedetomidine on postoperative delirium in elderly patients after laparoscopic major non-cardiac surgery: a double blind randomized controlled study.J Clin Anesth. 2018; 47: 27-32
- Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial.Lancet. 2016; 388: 1893-1902
- Clarifying confusion: the confusion assessment method. A new method for detection of delirium.Ann Intern Med. 1990; 113: 941-948
- The Richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients.Am J Respir Crit Care Med. 2002; 166: 1338-1344
- IL-6 in inflammation, autoimmunity and cancer.Int Immunol. 2021; 33: 127-148
- Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review.Surgery. 2015; 157: 362-380
- Systemic inflammation is an independent predictive marker of clinical outcomes in mucosal squamous cell carcinoma of the head and neck in oropharyngeal and non-oropharyngeal patients.BMC Cancer. 2016; 16: 124
- Association of duration of surgery with postoperative delirium among patients receiving hip fracture repair.JAMA Netw Open. 2019; 2e190111
- The neuroinflammatory hypothesis of delirium.Acta Neuropathol. 2010; 119: 737-754
- Time-course of cytokines during delirium in elderly patients with hip fractures.J Am Geriatr Soc. 2008; 56: 1704-1709
- Inflammatory mediators in the elderly.Exp Gerontol. 2004; 39: 687-699
- Priming microglia for innate immune memory in the brain.Trends Immunol. 2019; 40: 358-374
- Preventive effects of dexmedetomidine on the development of cognitive dysfunction following systemic inflammation in aged rats.J Anesth. 2017; 31: 25-35
- Inflammatory markers in postoperative delirium (POD) and cognitive dysfunction (POCD): a meta-analysis of observational studies.PLoS One. 2018; 13e0195659
Published online: February 07, 2023
Accepted: January 11, 2023
Received: July 4, 2022
Publication stageIn Press Corrected Proof
© 2023 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.