Boxtel, J. van (Jorke) (2017) Pre-operative risk factors for the development of postoperative delirium after radical cystectomy: a pilot study. thesis, Medicine.
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Abstract
Background: worldwide the population is ageing. Consequently, there is an increase in diseases that mainly occur in the elderly. Among those diseases is bladder cancer. The golden standard therapy for muscle invasive bladder cancer is a radical cystectomy, major surgery with high complication rates. A postoperative delirium is a commonplace complication in frail elderly after major surgery. Frail elderly are increasingly being evaluated by geriatrics through a comprehensive geriatric assessment (CGA). For orthopedic, vascular and colorectal surgery, preoperative predictors have been identified for postoperative delirium in vulnerable elderly people. However, for urological surgery, and especially for a radical cystectomy, this has not been investigated yet. Aim: the aim of the study was to identify preoperative risk factors for the development of delirium after a radical cystectomy. Furthermore, we were looking for an association between variables in the comprehensive geriatric assessment and readmission, length of stay, complications and survival. Ultimately, this was an exploratory study to see if the variables in the comprehensive geriatric assessment were objective or needed to be adapted. Methods: all patients who underwent a radical cystectomy and were preoperatively evaluated by the geriatrics, between January 2010 and April 2017 in the Martini hospital Groningen, were included. The main endpoint of this study was the development of a delirium. Secondary endpoints of this study were readmission, length of stay, complications noted according to the Clavien-Dindo classification and survival. Patient characteristics existed of demographic data and variables from the comprehensive geriatric assessment, concerning polypharmacy, (i)ADl-status, mobility, smoking status, alcohol intake, visual and hearing impairments, BMI, nutritional status, risk estimation for the development of a delirium, and estimated blood loss during surgery. The Pearson chisquare test, Fishers exact test, Mann-Whitney U test and Kruskall Wallis test were used for statistical analysis. Results: thirty-five patients were included in this study. Out of these thirty-five patients, ten patients developed a delirium within 90-days postoperative. Univariate predictors for a postoperative delirium were ADL-dependency and smoking status at time of admission. A non-significant trend was seen for (i)-ADL dependency. For the secondary outcomes; readmission and length of stay, no predictors were found. For the complications falling under Clavien-Dindo grades 1,2 and 4 no predictors were found. Patients with a grade 3 complications had a significant higher BMI. Conclusion: preoperative risk factors for the development of a postoperative delirium after a radical cystectomy have been identified for frail elderly. However, there was not corrected for confounders. Moreover, studies with large sample sizes are needed to validate the results from the current study. Additionally, variables have to be converted into clearly measurable variables.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisors: and Verkuyl, J. and Wymenga, L.F.A. and Department: Geriatrics + Urology Institution: Martini Zieken |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1037 |
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