Preoperative alcohol consumption, intraoperative bleeding and postsurgical pain may increase the risk of postoperative delirium in patients undergoing radical retropubic prostatectomy

Nikola Ladjević; Nebojša Nick Knežević; Andjela Magdelinić; Ivana Likić Ladjević; Otaš Durutović; Dušica Stamenković; Vesna Jovanović; Nebojša Ladjević

doi:10.2298/VSP190303088L

Nikola Ladjević University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Nebojša Nick Knežević Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL, USA
Andjela Magdelinić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Ivana Likić Ladjević University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Otaš Durutović University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Dušica Stamenković Military Medical Academy, Department of Anesthesiology and Intensive Therapy, Belgrade, Serbia
Vesna Jovanović University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Nebojša Ladjević University of Belgrade, Faculty of Medicine, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP190303088L

Keywords: delirium, postoperative complications, alcohol consumption, bleeding, postoperative pain, risk factors, prostatectomy

Abstract

Background/Aim. The incidence of postoperative delirium (POD) after non-cardiac surgery is a problem not often recognized by many anesthesiologists. The objective of our study was to detect POD and its possible cause, in patients undergoing radical retropubic prostatectomy (RRP) under general anesthesia. Methods. After Ethical Committee approval, we enrolled 80 patients, ASA (the American Society of Anestesiology) status II, scheduled to undergo RRP under general anesthesia, in a prospective study. All patients completed MMSE tests (the Folstein Mini Mental State Exam) the evening before, and 48 hours after the surgery. Assessment for the presence and severity of delirium was performed using CAM (the Confusion Assessment Method), and an assessment of the degree of agitation and sedation using RASS (the Richmond Agitation and Sedation Scale). Results. The average preoperative MMSE score (28.59 ± 1.04) significantly decreased following the surgery (27.74 ± 1.52) (p < 0.0001). The average postoperative MMSE score trend descended in correlation to intraoperative bleeding (p = 0.036). The patients with higher pain scores had significant decline in MMSE after the surgery (28.75 vs. 26.25; p < 0.001). Five patients were considered positive for delirium, and four of them reported regular alcoholic drinks intake (> 1 drink per day) preoperatively (p < 0.0001). Based on RASS score, 13 patients (16.3%) were agitated or sedated, and they had statistically significantly higher intraoperative bleeding (p < 0.001). Conclusion. Results of this study emphasize the importance of proper preoperative evaluation; especially regarding the alcohol consumption since all the patients that developed POD reported moderate alcohol consumption. Furthermore, greater intraoperative bleeding and postoperative pain scores did not influence the occurrence of delirium, but resulted in lower postoperative MMSE scores, which highlights the importance of adequate intraoperative treatment of patients during surgery and anesthesia in order to reduce the risk of developing POD.

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