Postoperative Delirium is Not Associated with Long-Term Decline in Activities of Daily Living or Mortality After Laryngectomy

Abstract

Purpose

To determine the relationships between postoperative delirium (POD) and postoperative activities of daily living (ADL) and mortality in patients undergoing laryngectomy. We hypothesized that POD would reduce postoperative ADL and increase postoperative mortality.

Patients and Methods

The prospective study included older participants (age ≥65 y) undergoing total laryngectomy, partial laryngectomy, total laryngectomy plus neck dissection, or partial laryngectomy plus neck dissection under general anesthesia. The diagnosis of delirium was based on the Confusion Assessment Method algorithm, which was administered on postoperative days 1 through 6. ADL were evaluated using the Chinese version of the Index of ADL scale. Follow-up assessments of ADL and mortality were conducted 24 months after surgery.

Results

Of 127 participants (aged 70.3 ± 4.1 y), 19 (15.0%) developed POD. POD was not associated with a decrease in ADL after laryngectomy (p=0.599) nor with an increase in postoperative mortality [3/19 (15.8%) vs 12/108 (11.1%), p=0.560, Log rank test]. However, longer surgery duration was significantly associated with worse overall survival (OR, 3.262; 95% CI, 1.261–9.169, p=0.025).

Conclusion

POD was not associated with long-term ADL or mortality after laryngectomy. Prolonged surgery was the only factor associated with a higher postoperative mortality rate.

Keywords:

• laryngeal cancer
• postoperative delirium
• activities of daily living
• outcome

Author Contributions

Xia Shen: study concept and design; critical revision of the manuscript for important intellectual content; study supervision; final approval of the version to be published; and agreement to be accountable for all aspects of the work. Yiru Wang: study concept and design; acquisition, analysis, and interpretation of data; drafting and revision of the manuscript; final approval of the version to be published; and agreement to be accountable for all aspects of the work. Weiwei Liu: study concept and design; acquisition, analysis, and interpretation of data; administrative, technical, and material support; drafting and revision of the manuscript; final approval of the version to be published; and agreement to be accountable for all aspects of the work. Kaizheng Chen: acquisition, analysis, and interpretation of data; administrative, technical, and material support; drafting of the manuscript; final approval of the version to be published; and agreement to be accountable for all aspects of the work. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.