title: Development of a nomogram for predicting the probability of postoperative delirium in patients undergoing free flap reconstruction for head and neck cancer.
abstract: OBJECTIVE
  To develop nomogram for prediction of postoperative delirium (POD) in patients undergoing ablative and reconstruction surgery for head and neck cancer.
  
  
  METHODS
  Total 341 patients were retrospectively analyzed, and clinical variables in preoperative, intraoperative and postoperative periods were compared between delirium group (n = 89) and non-delirium group (n = 252). Multivariate logistic regression, receiver operating characteristics curve, and area under the curve (AUC) were used to generate and test a nomogram, which performance was evaluated by 10-fold cross validation (CV) procedure.
  
  
  RESULTS
  In univariate and multivariate analysis, age, history of psychiatric disorder, marital status, preoperative numeric rating scale for pain, ASA classification, and ICU stay period were identified as significant risk factors. Using these factors, nomogram for predicting the POD was developed and it showed sensitivity of 61.8%, specificity of 75.4%, PPV of 47.0%, and NPV of 84.8% (Youden's index of 0.372). In 10-fold cross validation set, corresponding values were 44.9%, 84.1%, 50.0% and 81.2% (Youden's index of 0.337). AUC was comparable between two sets (0.7407 and 0.6898).
  
  
  CONCLUSIONS
  Proposed nomogram showed fair discriminative power for POD risk in head and neck cancer patients undergoing major surgery.
authors: Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: N Y
authors: NY
authors: Choi
authors: Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: E H
authors: EH
authors: Kim
authors: Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: C H
authors: CH
authors: Baek
authors: Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, South Korea.
authors: I
authors: I
authors: Sohn
authors: Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, South Korea.
authors: S
authors: S
authors: Yeon
authors: Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: chungmk@skku.edu.
authors: M K
authors: MK
authors: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D015995:Prevalence; D012372:ROC Curve; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology; D014140:Tracheotomy / Q000706:statistics & numerical data
keywords: Cancer; Delirium; Head and neck; Nomogram; Reconstruction; Surgery