Risk factors for postoperative delirium in patients undergoing microvascular decompression

RESEARCH ARTICLE Risk factors for postoperative delirium in patients undergoing microvascular decompression Zhenhua He ID1☯*, Huijuan Cheng2☯, Haiyang Wu1☯, Guodong Sun2, Jingmin Yuan3* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, Gansu Province, People’s Republic of China, 2 Gansu Provincial Key Laboratory of Digestive System Tumors, Lanzhou University Second Hospital, Lanzhou, Gansu Province, People’s Republic of China, 3 Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu Province, People’s Republic of China ☯ These authors contributed equally to this work. * (ZH); (JY) Abstract OPEN ACCESS Citation: He Z, Cheng H, Wu H, Sun G, Yuan J (2019) Risk factors for postoperative delirium in patients undergoing microvascular decompression. PLoS ONE 14(4): e0215374. https://doi.org/10.1371/journal.pone.0215374 Editor: Raffaele Serra, University Magna Graecia of Catanzaro, ITALY Received: January 8, 2019 Accepted: April 2, 2019 Published: April 18, 2019 Copyright: © 2019 He et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This study is to identify the risk factors for postoperative delirium (PODE) in patients undergoing microvascular decompression (MVD) for the treatment of primary cranial nerve disorders. We retrospectively reviewed the data of 912 patients (354 men, 558 women) with primary cranial nerve disorders (trigeminal neuralgia, 602 patients; hemifacial spasm, 296 patients; glossopharyngeal neuralgia, 14 patients) who underwent MVD in the Neurosurgery Department of Lanzhou University Second Hospital between July 2007 and June 2018. Potential risk factors for PODE were identified using univariate and multivariate stepwise logistic regression analysis.Of the 912 patients, 221 (24.2%) patients developed PODE. Patients with PODE were significantly older and significantly more likely to be male than patients without PODE. A history of hypertension, preoperative carbamazepine therapy, and postoperative sleep disturbance and tension pneumocephalus were independently associated with PODE. Variables such as body-mass index, smoking and drinking habits, cardiac disease, diabetes mellitus, cerebrovascular disease, mean operative time, affected vessel, mean blood loss, postoperative intensive care unit stay, postoperative fever (>38˚C), and routine laboratory results were not associated with PODE in our patients. PODE is a common complication after MVD, and is associated with multiple risk factors, including old age, male sex, hypertension, preoperative carbamazepine use, postoperative sleep disturbance, and tension pneumocephalus. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: This study was supported by grant number: 81560416, to HZH, funded by National Natural Science Foundation Project of China, http:// www.nsfc.gov.cn/; grant number: 145RJYA256, to HZH, funded by Natural Science Foundation Project of Gansu province, http://www.gsstc.gov.cn/; grant number: 17JR5RA241, to HZH, funded by Natural Science Foundation Project of Gansu province, http://www.gsstc.gov.cn/; grant number: CY2017- Introduction Microvascular decompression (MVD) is widely recognized as the neurosurgical treatment of choice for patients with primary cranial nerve disorders, including trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia, as well as various neurovascular compressions [1]. However, delirium is a common complication after MVD surgery, with reported incidence rates of 14.9%–27.3% [2]. This postoperative delirium (PODE) is an acute but transient organic brain syndrome characterized by inattention and altered levels of consciousness [3]. PLOS ONE | https://doi.org/10.1371/journal.pone.0215374 April 18, 2019 1/9 Postoperative delirium in patients after MVD procedure MS11, to HZH, funded by Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital, http://www.lzush.com. cn/; grant number: GSWSKY2018-39, to HZH, funded by Gansu health industry planning project under the grant, http://www.gsws.gov.cn/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. The development of PODE after MVD procedures tends to prolong hospital stays and increase medical costs as well as morbidity and mortality [4]. However, few studies have focused on PODE in patients undergoing MVD surgery [2, 5], and the exact pathogenesis of this complication remains poorly understood. A deeper understanding of the risk factors for PODE is required to identify at-risk patients as well as possible therapeutic interventions. Therefore, in this study, we aimed to identify the independent risk factors for PODE after MVD surgery in a large cohort of patients with primary cranial nerve disorders. We hope that our findings will indicate possible clinical interventions that might minimize the risk of PODE in this patient population. Methods Patients This retrospective study involved patients with primary cranial nerve disorders who underwent MVD procedures in the Neurosurgery Department of Lanzhou University Second Hospital between July 2007 and June 2018. None of the patients had any abnormalities on preoperative imaging, such as multiple sclerosis, vascular malformation, and tumor. Furthermore, no patient had a history of psychiatric disease. All patients underwent MVD under general anesthesia by the same senior neurosurgeon performing the same surgical technique. This study was approved by the ethics committee of Lanzhou University Second Hospital Medical (2018A-005) and was conducted in accordance with the principles of the Declaration of Helsinki. The requirement for individual informed consent was waived by the ethics committee, as this was a retrospective study of electronic medical records. Diagnostic criteria for PODE For all patients, delirium observation screening scores were calculated three times a day, from day 2 to day 5 after the surgery [6]. For patients with scores of three or greater, a psychiatrist consult was requested to confirm the diagnosis of PODE according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM V, 2013) [7]. Patients who did not develop delirium during the first 5 days after the surgery were included in the non-PODE group. Data collection We collected data on pre-, intra-, and postoperative variables. The preoperative variables included age, sex, body-mass index, smoking (tobacco use within 3 months before surgery), drinking (alcohol use within 3 months before surgery), cardiac disease (...truncated)