Risk factors involved in the onset of postoperative delirium after transurethral prostatectomy in elderly- a retrospective study


Introduction: The elderly represent a large cohort of patients undergoing urological procedures in which transurethral prostatectomy (TURP) is one of the most frequently performed. The aim of this study was to investigate the incidence of postoperative delirium (POD) in elderly patients undergoing monopolar TURP for benign prostatic hyperplasia (BPH) and to identify the risk factors involved in the onset and severity of POD. Material and method: 240 patients aged over 70 years underwent elective surgery for BPH in our Department in the last 2 years. Pts. were evaluated preoperatively, immediately postoperative and at 5 days after surgery. Inclusion criteria: spinal anesthesia; preoperative minimental state examination (MMSE)>27. Pts. with preoperative antidepressants or who developed postTUR syndrome were excluded. Delirium was diagnosed using the Confusion Assessment method (CAM). After surgery, patients were divided into 3 groups based on POD severity (no delirium, lasted 2-3 days and >4 days). Intraoperative data included operating time, TAM, HR, SpO2, rectal temperature, blood loss, volume of rinsing liquid used. POD treatment consisted in titrated haloperidol; pain management and non-pharmacological measures. For comparison between these 3 groups we used Mann-Whitney U test for continuous data, Kruskall Wallis test for non parametric variables and χ2 test for ordinal data. Results: Median age was 76.3 (70-87). POD occurred in 27 pts (11.25%), with 17 (7.08%) and 10 (4.16%) pts. developed short and prolonged POD, respectively.  Mean hospital stay was 5.4, 7.3 and 12.6 days for the 3 groups, respectively (p<0.004). 5 (2.08%) pts. required endoscopic revision after POD onset but no significant surgical complication (Clavien grade>3a) was recorded. Age>76, marital status, alcohol use disorders, preoperative urinary catheterization were found to be preoperative predictors for onset of POD. Prolonged POD was associated with intraoperative Hb drop>2g/dL, increased operative time>60 min and decrease of intraoperative body temp<36,50 C. MMSE did not correlate with POD severity in this cohort. Conclusions: Reducing the operative time, usage of preheated rinsing liquids in association with specific treatment may decrease POD morbidity and hospitalization costs. Reference: American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults: Postoperative delirium in older adults, J Am Coll Surg. 2015 Feb;220(2):136-48.e1 Acknowledgements: none

Risk factors involved in the onset of postoperative delirium after transurethral prostatectomy in elderly - a retrospective study