Abstract
Objective
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: February 07, 2023
Accepted:
January 11,
2023
Received:
July 4,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.
