Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2022; 10(21): 7341-7347
Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7341
Risk factors for delirium after surgery for craniocerebral injury in the neurosurgical intensive care unit
Ri-Yu Chen, Chang-Hui Zhong, Wei Chen, Ming Lin, Chang-Fu Feng, Chang-Neng Chen
Ri-Yu Chen, Radiology Department Intervention Room, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, Hainan Province, China
Chang-Hui Zhong, Wei Chen, Department of Critical Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou 570100, Hainan Province, China
Ming Lin, Chang-Fu Feng, Chang-Neng Chen, Second Ward, Department of Critical Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
Author contributions: Chen RY and Zhong CH contributed equally to this manuscript, and considered as co-first authors; Chen W, Lin M, Feng CF, and Chen CN contributed to the writing of the manuscript; All authors have read and agreed to the published version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Hainan People’s Hospital/Hainan Hospital Affiliated to Hainan Medical University Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang-Neng Chen, BMed, Attending Doctor, Second Ward, Department of Critical Medicine, The Second Affiliated Hospital of Hainan Medical University, No. 48 Baishuitang Road, Longhua District, Haikou 570311, Hainan Province, China. 634117300@qq.com
Received: March 8, 2022
Peer-review started: March 8, 2022
First decision: April 13, 2022
Revised: May 6, 2022
Accepted: May 27, 2022
Article in press: May 27, 2022
Published online: July 26, 2022
Processing time: 124 Days and 23.5 Hours
Abstract
BACKGROUND

Postoperative delirium is common in patients who undergo neurosurgery for craniocerebral injury. However, there is no specific medical test to predict postoperative delirium to date.

AIM

To explore risk factors for postoperative delirium in patients with craniocerebral injury in the neurosurgery intensive care unit (ICU).

METHODS

A retrospective analysis was performed in 120 patients with craniocerebral injury admitted to Hainan People’s Hospital/Hainan Hospital Affiliated to Hainan Medical University, The First Affiliated Hospital of Hainan Medical University, and The Second Affiliated Hospital of Hainan Medical University between January 2018 and January 2020. The patients were categorized into groups based on whether delirium occurred. Of them, 25 patients with delirium were included in the delirium group, and 95 patients without delirium were included in the observation group. Logistic regression analysis was used to explore the association between sex, age, educational level, Glasgow coma scale (GCS), complications (with or without concussion, cerebral contusion, hypoxemia and ventricular compression) and site of injury and delirium.

RESULTS

The GCS score above 8 and concomitant disease of cerebral concussion, cerebral contusion, hypoxemia and ventricular compression, and damage to the frontal lobe were associated with delirium in patients admitted to neurosurgical intensive care unit (ICU) (all P < 0.05). However, age, sex, administration more than three medicines, and educational level were not significantly associated with the onset of delirium in patients with craniocerebral injury in the neurosurgical ICU (P < 0.05). Multivariate logistic regression analysis showed that GCS score above 8, cerebral concussion, cerebral contusion, hypoxemia, ventricle compression, and frontal lobe disorders were independent risk factors for delirium in patients with craniocerebral injury in the neurosurgical ICU (P < 0.05).

CONCLUSION

GCS score, concussive concussion, cerebral contusion, hypoxemia, ventricle compression, and damage to frontal lobe are risk factors of postoperative delirium.

Keywords: Brain injury; Delirium; Neurosurgery; Intensive care unit; Risk factors

Core Tip: Neurosurgical patients with craniocerebral injury are at high risk of developing postoperative delirium. Investigating predictive factors for postoperative delirium will aid in early implementation to greatly reduce the risk. This study analyzed the association between age, sex, use of medicines, Glasgow coma scale score (GCS), comorbid diseases, and injury sites and onset of delirium in patients with craniocerebral injury in the neurosurgical intensive care unit. The results of this study suggest that GCS score above 8, comorbid diseases of cerebral concussion, cerebral contusion, hypoxemia and ventricular compression, and frontal lobe injury might contribute to delirium in this population.