Thoracic delirium index for predicting postoperative delirium in elderly patients following thoracic surgery: A retrospective case-control study

BackgroundPostoperative delirium (POD) is an acute neurological complication in the elderly undergoing thoracic surgery and can result in serious adverse consequences.AimsThis study aimed to identify the related risk factors for POD following thoracic surgery, primarily focusing on preoperative serum biomarkers, and further to establish a novel delirium index to better predict POD.MethodsA total of 279 patients aged >= 60 years who underwent elective thoracic surgery from August 2021 to August 2022 were enrolled in this observational study. The platelet-to-white blood cell ratio (PWR) was calculated as number the of platelets divided by the number of white blood cells. POD was defined by the confusion assessment method twice daily during the postoperative first 3 days. Multivariate regression analysis was performed to identify all potential variables for POD. Moreover, a novel thoracic delirium index (TDI) was developed based on the related risk factors. The accuracy of TDI and its component factors in predicting POD was determined by the curve of receiver operating characteristic (ROC).ResultsIn total, 25 of 279 patients developed POD (8.96%). Age, PWR, and average pain scores within the first 3 days after surgery were regarded as the independent risk factors for POD. Moreover, the ROC analysis showed the TDI, including age, PWR, and average pain scores within the first 3 days after surgery, can more accurately predict POD with the largest area under the curve of 0.790 and the optimal cutoff value of 9.072, respectively.ConclusionThe TDI can scientifically and effectively predict POD to provide optimal clinical guidance for older patients after thoracic surgery. Postoperative delirium (POD) can be prevented in elderly patients undergoing thoracic surgery by identifying its risk factors. The thoracic delirium index could early identify people at risk of POD, thus improving the prognosis of patients. Clinicians can reduce POD in the elderly after thoracic surgery by improving nutritional status before surgery, monitoring infectious signs using multiple objective laboratory results, and managing the pain after surgery. image