Patient-related and anesthesia-dependent determinants for postoperative delirium after oral and maxillofacial surgery. Results from a register-based case-control study

Objective: To identify risk factors for postoperative delirium (POD) after general oral and maxillofacial surgery. Material and methods: 2420 patients were screened postoperatively for POD using the Nursing Delirium Screening Scale (NuDESC) before discharge from the post anesthesia caring unit (PACU). Basic health data and risk factors were collected. For analysis the study group (n = 41) was compared to a control group of 164 randomly selected patients (case-control-ratio = 1:4). To identify risk factors for POD multivariable logistic regression models were used. To see whether estimations remain stable, regression analysis was repeated for the subgroup of patients not undergoing dentoalveolar surgery (n = 105). To estimate the risk for dentoalveolar surgery a logistic regression model was performed. Results: Dementia was the only significant risk factor for POD (Odds ratio 41.5; 95% CI 5.48-314), also for patients undergoing other than dentoalveolar surgery (58.1; 1.70-1983). Patients undergoing dentoalveolar surgery were more often suffering from dementia (35.5; 2.85-441), other psychiatric and neurological disorders (3.15; 1.05-9.43), were of younger age (0.97; 0.94-1.00) and had higher anesthesiological risk (3.95; 1.04-14.9). Conclusion: Patients with dementia are at higher risk to develop POD after oral and maxillofacial surgery. We found a strong interdependence between age, dementia, ASA-Score and dentoalveolar surgery. (C) 2020 Published by Elsevier Masson SAS.

Automated summary

Dementia was found to be the only significant risk factor for postoperative delirium (POD) after general oral and maxillofacial surgery, with patients suffering from dementia at a higher risk of developing POD. Patients undergoing dentoalveolar surgery were typically younger, had higher anesthesiological risk, and were more likely to have other psychiatric and neurological disorders.