Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches

Abstract

Background: Postoperative delirium is a frequent complication in elderly patients undergoing major abdominal surgery and is associated with a poor outcome. We compared postoperative delirium in elderly patients following laparoscopic gastrectomy (LG) versus open gastrectomy (OG).

Methods: In total, 130 patients aged ≥ 65 years with gastric cancer undergoing LG and OG were enrolled prospectively. Postoperative delirium and cognitive status were assessed daily using the Confusion Assessment Method (CAM) and Mini-Mental Status Examination (MMSE), respectively, for 3 days postoperatively. For CAM-positive patients, delirium severity was then assessed using the Delirium Index (DI).

Results: In total, 123 subjects (LG, n = 60; OG, n = 63) were included in the analysis. In both groups, the overall incidences of postoperative delirium were similar: 31.6% (19/60) in the LG group and 41.2% (26/63) in the OG group. When considering only those with delirium, the severity, expressed as the highest DI score, was similar between the groups. A decline in cognitive function (reduction in MMSE ≥ 2 points from baseline) during 3 days postoperatively was observed in 23 patients in the LG group (38.3%) and 27 patients in the OG group (42.9%) (P = 0.744). In both groups, postoperative cognitive decline was significantly associated with postoperative delirium (P < 0.001).

Conclusions: We found that, compared with traditional open gastrectomy, laparoscopic gastrectomy did not reduce either postoperative delirium or cognitive decline in elderly patients with gastric cancer.

Keywords: Aged; Delirium; Gastrectomy; Laparoscopy.

Fig. 1. CONSORT flow diagram. MMSE: Mini-Mental State Examination.

Fig. 2. Individual prevalence of delirium on postoperative days (POD) 1, 2, and 3, and overall incidence of delirium in the 3 days postoperatively in the open gastrectomy (OG) and laparoscopic gastrectomy (LG) groups. There was no significant difference between the groups in the individual prevalence of delirium on POD 1, 2 or 3 (P = 0.697, P = 0.055, and P = 0.094, respectively). There was no significant difference between the groups in the overall incidence of delirium during the 3 days postoperatively (P = 0.359).

Fig. 3. Individual prevalence of cognitive decline on postoperative days (POD) 1, 2, and 3, and overall incidence of cognitive in the 3 days postoperatively in the open gastrectomy (OG) and laparoscopic gastrectomy (LG) groups. There was no significant difference between the groups in the individual prevalence of cognitive decline on POD 1, 2, or 3 (P = 0.982, P = 0.174, and P = 0.111, respectively). There was no significant difference between the groups in the overall incidence of cognitive decline during 3 days postoperatively (P = 0.744).