Preoperative Risk Assessment for Delirium After Hepatic Resection in the Elderly: a Prospective Multicenter Study



Hepatic resection often results in delirium in preoperatively self-sufficient elderly people. The association of frailty with postoperative delirium remains unclear, and preoperative risk assessment, including frailty, of postoperative delirium has not been established.


This prospective multicenter study included 295 independently living patients aged ≥ 65 years scheduled for initial hepatic resection. All patients answered the phenotypic frailty index Kihon Checklist, which is a self-reporting list of 25 questions, within a week before surgery. The risk factors for postoperative delirium were investigated. Patients who scored ≥ 4 in the Intensive Care Delirium Screening Checklist were designated as having postoperative delirium.


Delirium developed after liver resection in 22 of 295 patients (7.5%). Total Kihon Checklist score (≥ 6 points), age (≥ 75 years), and serum albumin concentration (≤ 3.7 g/dL) were the independent risk factors for postoperative delirium. The proportion of patients with postoperative delirium was 0% in those with no applicable risk factors, 3.2% in those with one applicable risk factor, 12.0% in those with two applicable risk factors, and 40.9% in those with all three factors (p < 0.001). The area under the receiver operating characteristic curve for this risk assessment for predicting postoperative delirium was 0.842.


The use of these three factors for preoperative risk assessment may be effective in predicting and preparing for delirium after hepatic resection in elderly patients.

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We thank Drs. Tokuji Ito, Takayoshi Nishioka, Toru Miyazaki, and Shigekazu Takemura of the Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan; Yoshihiro Inoue of the Department of General and Gastroenterological Surgery, Osaka Medical College; Dr. Daisuke Hokuto of the Department of Surgery, Nara Medical University; Dr. Masataka Matsumoto of the Department of Surgery, Faculty of Medicine, Kinki University; Dr. Morihiko Ishizaki of the Department of Surgery, Hirakata Hospital, Kansai Medical University; Dr. Rei Morimura of the Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine; and Dr. Takehiro Noda of the Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University for their significant contributions to the manuscript. Moreover, we are indebted to all the surgeons who participated in this study for their collection of data for the Osaka Liver Surgery Study Group.


This work was supported by the Health, Labour and Welfare Policy Research Grants from the Ministry of Health, Labour, and Welfare of Japan (Policy Research for Hepatitis Measures [H30-Kansei-Shitei-003]).

Author information




Project development: A Ishihara, S Tanaka, M Ueno, H Iida, M Kaibori, T Nomi, F Hirokawa, H Ikoma, T Nakai, H Eguchi, T Shibata, and S Kubo

Acquisition, analysis, and interpretation of data: A Ishihara, S Tanaka, M Ueno, H Iida, T Nomi, F Hirokawa, H Ikoma, T Nakai, H Shinkawa, S Hayami, and H Maehira

Drafting of the manuscript: A Ishihara, and S Tanaka

Editing of the manuscript: All authors

Final approval: All authors

Agreement to be accountable for all aspects of the work: All authors

Corresponding author

Correspondence to Shogo Tanaka.

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Ishihara, A., Tanaka, S., Ueno, M. et al. Preoperative Risk Assessment for Delirium After Hepatic Resection in the Elderly: a Prospective Multicenter Study. J Gastrointest Surg 25, 134–144 (2021).

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  • Frailty
  • Hypoalbuminemia
  • Healthcare support
  • Transfer