Graft factors as determinants of postoperative delirium after liver transplantation
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ORIGINAL ARTICLE
Graft factors as determinants of postoperative delirium after liver transplantation D. Patrono1 · F. Rigo1 · S. Bormida1 · P. Berchialla2 · L. Giordanengo3 · S. Skurzak4 · R. Balagna4 · R. Romagnoli1 Received: 31 May 2020 / Accepted: 7 September 2020 © The Author(s) 2020
Abstract Post-operative delirium (POD) is a frequent complication after surgery, occurring in 15–20% of patients. POD is associated with a higher complications rate and mortality. Literature on POD after liver transplantation (LT) is limited, with the few available studies reporting an incidence of 10–47%. The aim of this study was analyzing pattern, risk factors and clinical impact of POD after LT. Data on donor and recipient characteristics, postoperative course and POD of consecutive adult LT recipients from March 2016 to May 2018 were prospectively collected and retrospectively analyzed. Risk factors for POD were analyzed using univariable logistic regression and Lasso regression. Kaplan–Meier method was used for survival analysis. 309 patients underwent LT during study period; 3 were excluded due to perioperative death. Incidence of POD was 13.4% (n = 41). The median day of onset was 5th (IQR [4–7]) with a median duration of 4 days (IQR [3–7]). Several risk factors, related to the severity of liver disease and graft characteristics, were identified. Graft macrovesicular steatosis was the only factor independently associated with POD at multivariable analysis (OR 1.27, CI 1.09–1.51, p = 0.003). POD was associated with a higher rate of severe postoperative complications and longer intensive care unit and hospital stay, but did not significantly impact on patient and graft survival. Incidence of POD after LT is comparable to that observed after general surgery and graft factors are strongly associated with its onset. These results help identifying a subset of patients to be considered for preventive interventions. Keywords Cognitive impairment · Postoperative delirium · Surgical quality · Ageing · Outcomes · Liver transplantation
Introduction Post-operative delirium (POD) is one of the most common postoperative complications. Delirium can be defined as a transient, mostly reversible organic-mental syndrome that includes confusion, cognitive impairment, decline of vigilance, increased or reduced psychomotor activity and * R. Romagnoli [email protected] 1
General Surgery 2U‑Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Corso Bramante 88‑90, 10126 Turin, Italy
2
Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
3
Regional Transplant Center, Unit of Medical Psychology for Transplantation, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
4
Anesthesia and Intensive Care Service 2, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
a disturbed sleep–wake cycle [1]. Prevalence in the general population is around 1–2%, whereas in hospitalized patients its incidence is 10–40%, with values rea
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