title: Decreased Incidence of Postoperative Delirium in Robot-assisted Thoracoscopic Esophagectomy Compared With Open Transthoracic Esophagectomy.
abstract: BACKGROUND
  Postoperative delirium (POD) is one of messy complications related with increased mortality and hospital costs. Patients undergoing esophagectomy are more in danger of delirium than other kinds of surgeries. We investigated the impact of robot-assisted thoracoscopic esophagectomy on the incidence of POD compared with open transthoracic esophagectomy.
  
  
  METHODS
  A retrospective review was completed for the patients who underwent esophagectomy from December 2, 2012 and April 15, 2015 (n=529). POD was assessed using Confusion Assessment Method for the Intensive Care Unit. The comparison of group differences between the robotic esophagectomy group (R group) and the open esophagectomy group (O group) was conducted with and without propensity score (PS) matching method. Univariate model was used for 247 PS-matched patients to calculate the odds ratio of potential risk factors of POD.
  
  
  RESULTS
  The incidence rate of POD was significantly lower among R group patients than O group (30% vs. 42%; P=0.035) after PS matching method. The risk of POD in R group was 0.55-fold lower than that of O group. Operative time and intraoperative blood loss were also significantly lower in R group patients.
  
  
  CONCLUSIONS
  In conclusion, robotic thoracoscopic esophagectomy lowers the incidence of POD 0.55-fold compared with open transthoracic esophagectomy.
authors.affiliation: *Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine †Department of Anesthesiology and Pain medicine, Gyeongsang National University Hospital, Seoul, Korea.
authors.forename: Dae Myoung
authors.initials: DM
authors.lastname: Jeong
authors.forename: Jie Ae
authors.initials: JA
authors.lastname: Kim
authors.forename: Hyun Joo
authors.initials: HJ
authors.lastname: Ahn
authors.forename: Mikyung
authors.initials: M
authors.lastname: Yang
authors.forename: Burn Young
authors.initials: BY
authors.lastname: Heo
authors.forename: Soo Hee
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000368:Aged; D003693:Delirium / Q000453:epidemiology* / Q000209:etiology; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications; D057216:Propensity Score; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*