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Preoperative Anxiety as a Predictor of Delirium in Cancer Patients: A Prospective Observational Cohort Study

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Abstract

Background

Postoperative delirium is a common and important complication in cancer patients. We need to identify patients at high risk of postoperative delirium such that it can be prevented preoperatively or in early postoperative phase. The aim of this study was to investigate whether preoperative anxiety predicted onset of postoperative delirium in cancer patients, not only in order to identify high-risk groups but also to help develop new preventive approaches.

Methods

This was a prospective observational cohort study of cancer patients undergoing tumor resections. Postoperative delirium was assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Preoperative anxiety was evaluated with the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), and we defined HADS-A > 7 as clinical anxiety. We conducted multivariate logistic regression to determine which factors were predictors of delirium.

Results

The final analysis included 91 patients, 29 of whom met the criteria for postoperative delirium. In multivariable logistic regression, age (5-year increments; odds ratio (OR) = 1.565, 95% confidence interval (CI) = 1.057–2.317, p = 0.025) and HADS-A > 7 (OR = 4.370, 95% CI = 1.051–18.178, p = 0.043) predicted delirium onset. These variables explained 74.2% of the variance.

Conclusions

Preoperative anxiety strongly predicted postoperative delirium in cancer patients. Our findings suggest that preoperative anxiety may be a new target for prevention of postoperative delirium.

Trial registration number This study was registered at UMIN000018980

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Acknowledgements

The authors express special gratitude to Yumi Kikukawa, CP and Koji Washizuka, CP for their help in conducting the study, and the physicians and nurses of the departments that cooperated with this study.

Funding

This work was supported by the National Cancer Center Research and Development Fund 26-A-29 from National Cancer Center in Japan.

Author information

Authors and Affiliations

  1. Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan

    Saho Wada, Hironobu Inoguchi, Ryoichi Sadahiro, Yutaka J. Matsuoka, Yosuke Uchitomi & Ken Shimizu

  2. Division of Health Care Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan

    Saho Wada, Ryoichi Sadahiro, Yutaka J. Matsuoka, Yosuke Uchitomi & Ken Shimizu

  3. Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan

    Yutaka J. Matsuoka & Ken Shimizu

  4. Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan

    Yosuke Uchitomi

  5. Department of Anesthesia and Intensive Care, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan

    Tetsufumi Sato

  6. Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan

    Kazuaki Shimada

  7. Department of Head and Neck Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan

    Seichi Yoshimoto

  8. Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan

    Hiroyuki Daiko

Authors
  1. Saho Wada
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  2. Hironobu Inoguchi
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  3. Ryoichi Sadahiro
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  4. Yutaka J. Matsuoka
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  5. Yosuke Uchitomi
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  6. Tetsufumi Sato
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  7. Kazuaki Shimada
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  8. Seichi Yoshimoto
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  9. Hiroyuki Daiko
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  10. Ken Shimizu
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Correspondence to Ken Shimizu.

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Wada, S., Inoguchi, H., Sadahiro, R. et al. Preoperative Anxiety as a Predictor of Delirium in Cancer Patients: A Prospective Observational Cohort Study. World J Surg 43, 134–142 (2019). https://doi.org/10.1007/s00268-018-4761-0

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  • DOI: https://doi.org/10.1007/s00268-018-4761-0

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