Predictive value of the G8 and the IADL-modified G8 screening tools for postoperative delirium following major urological cancer surgery

摘要

? 2022 Elsevier LtdIntroduction: The purpose of this study was to evaluate whether the Geriatric-8 (G8) and the instrumental activities of daily living (IADL)-modified G8 are associated with the occurrence of postoperative delirium after major urological cancer surgery. Materials and Methods: We retrospectively analyzed a total of 415 consecutive patients who underwent major urologic cancer surgery and were screened preoperatively using the G8 and the IADL-modified G8 at our institution between January 2020 and July 2021. For both the G8 and the IADL-modified G8, a cut-off value of 14 was used. All patients underwent perioperative management according to the Enhanced Recovery After Surgery protocol formulated at our institution. Delirium was diagnosed using the Confusion Assessment Method. The relationship between these screening tests and clinical variables was examined. Predictive accuracy was evaluated by the area under the receiver operating characteristic curve (AUC). To determine the risk factors for the occurrence of postoperative delirium, univariate and multivariate analyses were performed. Results: Of the 415 patients, 160 (39%) were assigned to the low G8 (score ≤ 14) group and 166 (40%) to the low IADL-modified G8 (score ≤ 14) group. The median age of the patients was 72 years. Postoperative delirium occurred in 31 patients (7%). The AUC values for predicting postoperative delirium were 0.69 for the G8 and 0.71 for the IADL-modified G8. Multivariate analysis for the G8 showed that G8 ≤ 14 (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.2–6.0; P = 0.02), preoperative use of benzodiazepine (OR = 3.8; 95% CI = 1.6–8.6; P = 0.002), and operative time ≥ 237 min (OR = 3.3; 95% CI = 1.5–7.1; P = 0.003) were independent risk factors for postoperative delirium. Similarly, for the IADL-modified G8, IADL-modified G8 ≤ 14 (OR = 2.6; 95% CI = 1.1–5.8; P = 0.02), preoperative use of benzodiazepine (OR = 3.9; 95% CI = 1.7–8.8; P = 0.001), and operative time ≥ 237 min (OR = 3.3; 95% CI = 1.5–7.2; P = 0.003) were independent risk factors for postoperative delirium. Discussion: The G8 and the IADL-modified G8 screening may allow for better identification of patients at risk of postoperative delirium.