title: Low hemoglobin level is associated with the development of delirium after hepatectomy for hepatocellular carcinoma patients.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide and liver resection is the only potential curative treatment option for those patients. Postoperative complications specific to elderly surgical patients such as delirium will be increasingly relevant in the coming decades. Herein, we aimed to investigate the risk factors for postoperative delirium in patients who have received hepatectomy for HCC.
  
  
  METHODS
  This is a single medical center observational study and the study subjects comprised 401 individuals who underwent liver resection for hepatocellular carcinoma during January 2009 to October 2013. Multivariate analysis was used to examine whether preoperative, intra-operative, or postoperative variables were associated with the development of delirium.
  
  
  RESULTS
  Of the 401 patients who underwent hepatectomy, 34 developed postoperative delirium (8.4%). In the majority of those patients, symptoms and signs of the syndrome occurred on postoperative day 2 and the mean duration of symptoms was 3.61 ± 3.71 days. Multivariate analysis revealed that advanced age (>71 years) [odds ratio (OR) = 1.133, 95% confidence interval (CI): 1.071-1.200, p<0.001], prolonged operative time (>190 minutes) (OR = 1.009, 95% CI: 1.000-1.017, p = 0.038), a decreased postoperative hemoglobin level (< 10.16 g/dL) (OR = 0.777, 95% CI: 0.613-0.983, p = 0.036), and history of hypnotic drug use (OR = 3.074, 95% CI: 1.045-9.039, p = 0.041) were independent risk factors for the development of postoperative delirium after hepatectomy.
  
  
  CONCLUSIONS
  Although the mechanism of postoperative delirium is not well understood, numbers of studies have shown that patients with postoperative delirium tend to have prolonged hospital stay, worse postoperative outcome and an increased risk of short- and long-term mortality. In this study, we found that advanced age, prolonged operative time, postoperative low hemoglobin level and history of hypnotic drug use are independent risk factors for postoperative delirium.
authors.affiliation: Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yao-Li
authors.initials: YL
authors.lastname: Chen
authors.affiliation: Department of Senior Citizen Welfare and Business, Hung Kuang University, Taichung, Taiwan.
authors.forename: Hui-Chuan
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Kuo-Hua
authors.initials: KH
authors.lastname: Lin
authors.affiliation: Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Li-Si
authors.initials: LS
authors.lastname: Lin
authors.affiliation: Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chia-En
authors.initials: CE
authors.lastname: Hsieh
authors.affiliation: Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chih-Jan
authors.initials: CJ
authors.lastname: Ko
authors.affiliation: Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yu-Ju
authors.initials: YJ
authors.lastname: Hung
authors.affiliation: Transplant Medicine & Surgery Research Centre, Changhua Christian Hospital, Changhua, Taiwan; Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan.
authors.forename: Ping-Yi
authors.initials: PY
authors.lastname: Lin
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D003693:Delirium / Q000209:etiology / Q000378:metabolism*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000378:metabolism*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006454:Hemoglobins