title: Incidence and risk factors of delirium in patients post pancreaticoduodenectomy.
abstract: BACKGROUND
  Post-operative delirium is an important and common complication of major abdominal surgery characterized by acute confusion with fluctuating consciousness. The aim of this study was to establish the incidence of post-operative delirium in patients undergoing a pancreaticoduodenectomy and to determine the risk factors for its development.
  
  
  METHODS
  From a prospectively maintained database, a retrospective cohort analysis was performed of 50 consecutive patients who underwent a pancreaticoduodenectomy at the National Surgical Centre for Pancreatic Cancer in St. Vincent's University Hospital, Dublin and whose entire post-operative stay was in this institution, between July 2011 and December 2012. Two independent medical practitioners assessed all data and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual Disorder (DSM), fourth edition. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Seven patients (14%) developed post-operative delirium. The median onset was on the second post-operative day. Older age was predictive of an increased risk of delirium post-operatively. Those who developed delirium had a significantly increased length of stay (LOS) as well as a significantly increased risk of developing at least a grade 3 complication (Clavien-Dindo classification).
  
  
  CONCLUSIONS
  This study demonstrates that post-operative delirium is associated with a more complicated recovery after a pancreaticoduodenectomy and that older age is independently predictive of its development. Focused screening may allow targeted preventative strategies to be used in the peri-operative period to reduce complications and costs associated with delirium.
authors.affiliation: Department of Hepatobiliary & Pancreatic Surgery, St. Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: Tom K
authors.initials: TK
authors.lastname: Gallagher
authors.forename: Sarah
authors.initials: S
authors.lastname: McErlean
authors.forename: Aimee
authors.initials: A
authors.lastname: O'Farrell
authors.forename: Emir
authors.initials: E
authors.lastname: Hoti
authors.forename: Donal
authors.initials: D
authors.lastname: Maguire
authors.forename: Oscar J
authors.initials: OJ
authors.lastname: Traynor
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Conlon
authors.forename: Justin G
authors.initials: JG
authors.lastname: Geoghegan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016208:Databases, Factual; D003693:Delirium / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007494:Ireland; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
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