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Arch Otolaryngol Head Neck Surg. 2012 Mar;138(3):266-71. doi: 10.1001/archoto.2011.1456.

Alcohol-related predictors of delirium after major head and neck cancer surgery.

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1
Department of Radiology, College of Medicine and The Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH 43201, USA.

Abstract

OBJECTIVE:

To identify specific alcohol-related predictors of postoperative delirium.

DESIGN:

Inception cohort, logistic regression with step-wise selection.

SETTING:

Ohio State University Comprehensive Cancer Center, Columbus.

PATIENTS:

A total of 774 patients undergoing major resection of head and neck squamous cell carcinoma.

MAIN OUTCOME MEASURES:

The correlation of 19 variables with postoperative delirium. One variable was an alcohol-related blood test: mean red blood cell volume (MCV). Eight variables were patient responses to alcohol-related questions.

RESULTS:

Eighty-nine of 774 surgical procedures (11.5%) were complicated by delirium. Six variables were significantly associated with delirium: age older than 69 years (odds ratio [OR], 2.43; P < .01), preexisting cognitive impairment (OR, 3.83; P < .01), surgery duration greater than 6 hours (OR, 2.40; P < .01), MCV greater than 95.0 femtoliters (OR, 2.23; P < .01), ever being advised to cut back on alcohol (OR, 2.25; P = .01), and not abstaining from alcohol for at least 1 continuous week in the preceding year (OR, 2.16; P = .02). The number of variables stratified delirium risk (0 variables: 198 patients, 2.5% incidence of delirium; 1 variable: 278 patients, 6% incidence of delirium; 2 variables: 206 patients, 18% incidence of delirium; and >2 variables: 92 patients, 34% incidence of delirium).

CONCLUSIONS:

Three clinical variables not related to alcohol drinking (age, preexisting cognitive impairment, and surgery duration), an alcohol-related laboratory test (MCV), and 2 alcohol-related questions ("At any time in your life, has anyone ever suggested that you should cut back on your drinking?" and "What is the greatest number of days in a row you have gone without an alcoholic drink in the past year?") may help in estimating a patient's risk for postoperative delirium.

PMID:
22431871
DOI:
10.1001/archoto.2011.1456
[Indexed for MEDLINE]
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