Intraoperative hypotension and postoperative delirium in elderly male patients undergoing laryngectomy: a single-center retrospective cohort study
Hipotensão intraoperatória e delírio pós-operatório em pacientes idosos do sexo masculino submetidos à laringectomia: um estudo de coorte retrospectivo de centro único
Yiru Wang, Kaizheng Chen, Min Ye, Xia Shen
Abstract
Background
Postoperative delirium (POD) is a common, transient postoperative cognitive dysfunction in elderly patients. The relationship between POD and intraoperative hypotension remains unclear. This study aims to determine if intraoperative hypotension predicts POD in elderly male patients undergoing laryngectomy.
Methods
This study included male patients over 65 years old who underwent laryngectomy between April 2018 and January 2022. The Confusion Assessment Method (CAM) was used to diagnose delirium. Intraoperative hypotension was defined as a Mean Arterial Pressure (MAP) during surgery that was less than 30% of the preoperative level for at least 30 minutes. The relationship between intraoperative hypotension and POD incidence was adjusted for patient demographics and surgery-related factors.
Results
Out of 428 male patients, 77 (18.0%) developed POD, and 166 (38.8%) experienced intraoperative hypotension. Surgery duration ≥ 300 minutes (OR = 1.873, 95% CI 1.041–3.241, p = 0.036), intraoperative hypotension (OR = 1.739, 95% CI 1.039–2.912, p = 0.035), and schooling (OR = 2.655, 95% CI 1.338–5.268) were independent risk factors for POD. The association between intraoperative hypotension and POD was significantly influenced by surgery duration (p for interaction = 0.008), with a stronger association in prolonged surgeries (adjusted OR = 4.902; 95% CI 1.816–13.230).
Conclusions
Intraoperative hypotension and low education level are associated with an increased risk of POD in elderly male patients undergoing laryngectomy, especially with prolonged surgery duration.
Keywords
Resumo
Introdução
O delírio pós-operatório (DPO) é uma disfunção cognitiva pós-operatória comum e transitória em pacientes idosos. A relação entre DPO e hipotensão intraoperatória permanece obscura. Este estudo tem como objetivo determinar se a hipotensão intraoperatória prevê DPO em pacientes idosos do sexo masculino submetidos à laringectomia.
Métodos
Este estudo incluiu pacientes do sexo masculino com mais de 65 anos submetidos à laringectomia entre abril de 2018 e janeiro de 2022. O Método de Avaliação de Confusão (CAM) foi usado para diagnosticar o delírio. A hipotensão intraoperatória foi definida como uma Pressão Arterial Média (MAP) durante a cirurgia que foi inferior a 30% do nível pré-operatório por pelo menos 30 minutos. A relação entre hipotensão intraoperatória e incidência de DPO foi ajustada para dados demográficos do paciente e fatores relacionados à cirurgia.
Resultados
De 428 pacientes do sexo masculino, 77 (18,0%) desenvolveram DPO e 166 (38,8%) apresentaram hipotensão intraoperatória. Duração da cirurgia ≥ 300 minutos (OR = 1,873, IC 95% 1,041–3,241, p = 0,036), hipotensão intraoperatória (OR = 1,739, IC 95% 1,039–2,912, p = 0,035) e escolaridade (OR = 2,655, IC 95% 1,338–5,268) foram fatores de risco independentes para DPO. A associação entre hipotensão intraoperatória e DPO foi significativamente influenciada pela duração da cirurgia (p para interação = 0,008), com uma associação mais forte em cirurgias prolongadas (OR ajustado = 4,902; IC 95% 1,816–13,230).
Conclusão
A hipotensão intraoperatória e o baixo nível de escolaridade estão associados a um risco aumentado de DPO em pacientes idosos do sexo masculino submetidos à laringectomia, especialmente com duração prolongada da cirurgia.
Palavras-chave
References
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Submitted date:
03/26/2024
Accepted date:
09/03/2024
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