Predictive Factors of Postoperative Delirium in Patients After Pancreaticoduodenectomy

  • Yoshito TomimaruEmail author
  • Sung Ae Park
  • Asuka Shibata
  • Shinichi Miyagawa
  • Kozo Noguchi
  • Shingo Noura
  • Hiroshi Imamura
  • Toru Shirakawa
  • Keizo Dono
Original Article



Postoperative delirium is a common serious complication after various types of surgery. However, the incidence and predictive factors associated with delirium after pancreaticoduodenectomy (PD) have not been investigated. Thus, this study aimed to investigate the incidence and predictive factors of postoperative delirium in patients who underwent PD.


This study included 155 consecutive patients who underwent PD. Patients with and without postoperative delirium were compared to identify differential patient characteristics. Multivariate regression analysis was used to statistically identify independent predictive factors significantly associated with the development of postoperative delirium.


Postoperative delirium developed in 27 (22.4%) of 155 patients. The majority of incidents occurred on postoperative day 2, and the mean delirium duration was 4.6 ± 4.8 days. Patients with postoperative delirium had an older age and a previous history of benzodiazepine use. A multivariate analysis revealed that the development of delirium was significantly correlated with these two factors. Receiver-operator characteristics (ROC) curve analysis of the two factors yielded an area under the ROC curve of 0.823 (0.750–0.896), suggesting good discrimination power.


This study reports on the incidence of postoperative delirium after PD. Furthermore, we identified age and use of benzodiazepines as significant predictive factors for developing delirium after PD. These results contribute to the prediction and treatment of postoperative delirium.


Delirium Postoperative delirium Pancreaticoduodenectomy 


Author Contributions

Study design: Y Tomimaru and SA Park.

Acquisition of data: Y Tomimaru, SA Park, A Shibata, S Miyagawa, and K Noguchi.

Analysis and interpretation: Y Tomimaru, SA Park, A Shibata, S Miyagawa, and T Shirakawa.

Manuscript preparation: Y Tomimaru and SA Park.

Assistance with data interpretation: S Noura, H Imamura, T Iwazawa, and K Dono.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22. Scholar
  2. 2.
    Marcantonio ER, Juarez G, Goldman L, Mangione CM, Ludwig LE, Lind L et al. The relationship of postoperative delirium with psychoactive medications. Jama. 1994;272(19):1518–22.CrossRefGoogle Scholar
  3. 3.
    Ogawa M, Izawa KP, Satomi-Kobayashi S, Kitamura A, Tsuboi Y, Komaki K et al. Preoperative exercise capacity is associated with the prevalence of postoperative delirium in elective cardiac surgery. Aging clinical and experimental research. 2018;30(1):27–34. Scholar
  4. 4.
    Park SA, Tomimaru Y, Shibata A, Miyagawa S, Noguchi K, Dono K. Incidence and Risk Factors for Postoperative Delirium in Patients After Hepatectomy. World journal of surgery. 2017;41(11):2847–53. Scholar
  5. 5.
    Takeuchi M, Takeuchi H, Fujisawa D, Miyajima K, Yoshimura K, Hashiguchi S et al. Incidence and risk factors of postoperative delirium in patients with esophageal cancer. Annals of surgical oncology. 2012;19(12):3963–70. Scholar
  6. 6.
    Tei M, Wakasugi M, Kishi K, Tanemura M, Akamatsu H. Incidence and risk factors of postoperative delirium in elderly patients who underwent laparoscopic surgery for colorectal cancer. International journal of colorectal disease. 2016;31(1):67–73. Scholar
  7. 7.
    Association AP. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013.CrossRefGoogle Scholar
  8. 8.
    Galanakis P, Bickel H, Gradinger R, Von Gumppenberg S, Forstl H. Acute confusional state in the elderly following hip surgery: incidence, risk factors and complications. International journal of geriatric psychiatry. 2001;16(4):349–55.CrossRefGoogle Scholar
  9. 9.
    Aldemir M, Ozen S, Kara IH, Sir A, Bac B. Predisposing factors for delirium in the surgical intensive care unit. Crit Care. 2001;5(5):265–70.CrossRefGoogle Scholar
  10. 10.
    Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. Jama. 1990;263(8):1097–101.CrossRefGoogle Scholar
  11. 11.
    Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of internal medicine. 1990;113(12):941–8.CrossRefGoogle Scholar
  12. 12.
    Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM et al. A clinical prediction rule for delirium after elective noncardiac surgery. Jama. 1994;271(2):134–9.CrossRefGoogle Scholar
  13. 13.
    Rudolph JL, Babikian VL, Birjiniuk V, Crittenden MD, Treanor PR, Pochay VE et al. Atherosclerosis is associated with delirium after coronary artery bypass graft surgery. Journal of the American Geriatrics Society. 2005;53(3):462–6. Scholar
  14. 14.
    Gallagher TK, McErlean S, O'Farrell A, Hoti E, Maguire D, Traynor OJ et al. Incidence and risk factors of delirium in patients post pancreaticoduodenectomy. HPB: the official journal of the International Hepato Pancreato Biliary Association. 2014;16(9):864–9. Scholar
  15. 15.
    Ito Y, Abe Y, Handa K, Shibutani S, Egawa T, Nagashima A et al. Postoperative Delirium in Patients after Pancreaticoduodenectomy. Digestive surgery. 2017;34(1):78–85. Scholar
  16. 16.
    Mizuno S, Takeuchi S, Kishiwada M, Mizutani N, Matsuda M, Sekoguchi N et al. Incidence and Risk Factors of Postoperative Delirium following Pancreatic Surgery: Does the Administration of TJ-54 Reduce the Incidence of Delirium. Digestive surgery. 2018;35(1):1–10. Scholar
  17. 17.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery. 2004;240(2):205–13.CrossRefGoogle Scholar
  18. 18.
    Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36.CrossRefGoogle Scholar
  19. 19.
    Harrell FE, Jr., Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15(4):361–87.<361::AID-SIM168>3.0.CO;2-4.CrossRefGoogle Scholar
  20. 20.
    Dyer CB, Ashton CM, Teasdale TA. Postoperative delirium. A review of 80 primary data-collection studies. Archives of internal medicine. 1995;155(5):461–5.CrossRefGoogle Scholar
  21. 21.
    Hammeke TA, Hastings JE. Neuropsychologic alterations after cardiac operation. The Journal of thoracic and cardiovascular surgery. 1988;96(2):326–31.Google Scholar
  22. 22.
    Smith LW, Dimsdale JE. Postcardiotomy delirium: conclusions after 25 years? The American journal of psychiatry. 1989;146(4):452–8. Scholar
  23. 23.
    Jung DM, Ahn HJ, Yang M, Kim JA, Kim DK, Lee SM et al. Hydroxyethyl starch is associated with early postoperative delirium in patients undergoing esophagectomy. The Journal of thoracic and cardiovascular surgery. 2018;155(3):1333–43. Scholar
  24. 24.
    Murakawa K, Kitamura Y, Watanabe S, Hongo S, Shinomiya K, Sendo T. Clinical risk factors associated with postoperative delirium and evaluation of delirium management and assessment team in lung and esophageal cancer patients. Journal of pharmaceutical health care and sciences. 2015;1:4. Scholar
  25. 25.
    van der Sluis FJ, Buisman PL, Meerdink M, Aan de Stegge WB, van Etten B, de Bock GH et al. Risk factors for postoperative delirium after colorectal operation. Surgery. 2017;161(3):704–11. Scholar
  26. 26.
    Chen YL, Lin HC, Lin KH, Lin LS, Hsieh CE, Ko CJ et al. Low hemoglobin level is associated with the development of delirium after hepatectomy for hepatocellular carcinoma patients. PloS one. 2015;10(3):e0119199. Scholar
  27. 27.
    Yoshimura Y, Kubo S, Shirata K, Hirohashi K, Tanaka H, Shuto T et al. Risk factors for postoperative delirium after liver resection for hepatocellular carcinoma. World journal of surgery. 2004;28(10):982–6. Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of SurgeryToyonaka Municipal HospitalOsakaJapan
  2. 2.Department of PsychiatryToyonaka Municipal HospitalToyonakaJapan
  3. 3.Public Health, Department of Social MedicineOsaka University Graduate School of MedicineOsakaJapan

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