title: Incidence, risk factors, and complications of postoperative delirium in elderly patients undergoing radical cystectomy.
abstract: OBJECTIVE
  To identify the risk factors for, and complications associated with, the development of delirium after radical cystectomy.
  
  
  METHODS
  From July 2008 to December 2009, 59 patients, aged ≥65 years and undergoing radical cystectomy, were prospectively enrolled. The baseline cognitive status was assessed using the Mini-Mental Status Examination. Postoperative delirium was assessed using the Confusion Assessment Method.
  
  
  RESULTS
  A total of 49 patients completed the surgery and all assessments. The incidence of postoperative delirium was 29%, with duration of 1-5 days. On univariate analysis, older age and preoperative Mini-Mental Status Examination score were associated with postoperative delirium. On multivariate analysis, only age was associated with postoperative delirium (odds ratio 1.52, 95% confidence interval 1.04-2.22, P=.03). The 2 groups did not differ in pathologic stage, length of surgery, intraoperative and postoperative narcotic usage, body mass index, age-adjusted Charlson comorbidity index, activities of daily living scores, smoking history, preoperative hematocrit, estimated blood loss, urinary tract infection, interval to a regular diet, or length of hospital stay. The patients who developed postoperative delirium were more likely to undergo readmission (odds ratio 10.7, 95% confidence interval 2.2-51.8, P=.01) and reoperation (odds ratio 9.2, 95% confidence interval 1.5-55.3, P=.03) but did not differ in the 90-day and 1-year mortality rates or incidence of postoperative complications.
  
  
  CONCLUSIONS
  In patients aged≥65 years, a lower preoperative Mini-Mental Status Examination score and older age were significantly associated with the development of postcystectomy delirium, as measured using the Confusion Assessment Method. The patients who developed delirium were more likely to undergo readmission and reoperation. Larger studies with multiple surgeons are needed to validate these findings.
authors.affiliation: University of Chicago Pritzker School of Medicine, Division of Urology, Department of Surgery, Chicago, Illinois, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Large
authors.forename: Chad
authors.initials: C
authors.lastname: Reichard
authors.forename: Joshua T B
authors.initials: JT
authors.lastname: Williams
authors.forename: Charles
authors.initials: C
authors.lastname: Chang
authors.forename: Sandip
authors.initials: S
authors.lastname: Prasad
authors.forename: Yiuka
authors.initials: Y
authors.lastname: Leung
authors.forename: Catherine
authors.initials: C
authors.lastname: DuBeau
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Bales
authors.forename: Gary D
authors.initials: GD
authors.lastname: Steinberg
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016001:Confidence Intervals; D015653:Cystectomy / Q000009:adverse effects*; D003693:Delirium / Q000209:etiology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008609:Mental Status Schedule; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D010865:Pilot Projects; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*