title: Impact of multicomponent, nonpharmacologic interventions on perioperative cortisol and melatonin levels and postoperative delirium in elderly oral cancer patients.
abstract: OBJECTIVE
  To investigate the impact of multicomponent, nonpharmacologic interventions (MNI) on perioperative cortisol and melatonin levels, as well as postoperative delirium (PD), in elderly oral cancer patients.
  
  
  METHODS
  A total of 160 elderly oral cancer patients who underwent tumor resection surgery and completed our investigation were included in this study. The cancer patients were randomly divided into 2 groups: Group U or Group I. During the perioperative period, Group U received usual care, while Group I received MNI, which is based on usual care and aims to decrease the risk of PD. MNI focused on general geriatric approaches and supportive nursing care. On the day before surgery and the first three postoperative days, nocturnal (20:00-8:00) urine samples were collected. The melatonin sulfate and cortisol levels in the urine samples were determined. Moreover, the RASS (Richmond Agitation Sedation Scale), CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) and QoR40 (40-item quality of recovery score) scores were dynamically monitored.
  
  
  RESULTS
  There were no significant differences in the general characteristics between the 2 groups. After surgery, the melatonin sulfate levels in the nocturnal urine of Group I were higher than those in Group U. The cortisol concentrations were lower in Group I compared to those in Group U. Group I achieved better postoperative RASS and QoR40 scores than Group U. Compared to Group U, Group I also experienced less PD (incidence and duration).
  
  
  CONCLUSIONS
  MNI ameliorated some postoperative disturbances regarding sleep and stress, decreased the incidence of PD and improved recovery quality.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China; Department of Anesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
authors.forename: Lulu
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Nursing, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
authors.forename: Peiyu
authors.initials: P
authors.lastname: Jia
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
authors.forename: Junfeng
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China. Electronic address: Dr_jianghong@163.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China. Electronic address: dr_jiangwei@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
mesh_terms: D000368:Aged; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D007362:Intensive Care Units; D008297:Male; D008550:Melatonin / Q000652:urine*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D057234:Preoperative Period; D011595:Psychomotor Agitation / Q000517:prevention & control; D012890:Sleep / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D008550:Melatonin; D006854:Hydrocortisone
keywords: Elderly patients; Intervention; Oral cancer; Postoperative delirium