Incidence and Risk Factors of Postoperative Delirium following Pancreatic Surgery: Does the Administration of TJ-54 Reduce the Incidence of Delirium

Dig Surg. 2018;35(1):1-10. doi: 10.1159/000456627. Epub 2017 Feb 8.

Abstract

Purposes: To clarify the incidence and risk factors of postoperative delirium in patients following pancreatic surgery, and the impact of yokukansan (TJ-54) administered to reduce delirium.

Methods: Fifty-nine consecutive patients who underwent pancreatic surgery (2012.4-2013.5) were divided into 2 groups: TJ-54 group: patients who received TJ-54 (n = 21) due to insomnia and the No-TJ-54 group: patients who did not receive TJ-54 (n = 38), and the medical records including the delirium rating scale - Japanese version (DRS-J) were retrospectively reviewed.

Results: Postoperative delirium occurred in 2 patients (9.5%) in the TJ-54 group and in 4 (10.5%) patients in the No-TJ-54 group (p = 0.90). The DRS-J on 5 days after surgery was lower in the TJ-54 group than in the No-TJ-54 group (rough p = 0.006), however, without any statistically significant differences with the Bonferroni correction. As for the hospital cost, there was no difference between the TJ-54 and the No-TJ-54 groups (p = 0.78). History of delirium was identified as an independent risk factor of postoperative delirium.

Conclusion: The patients with preoperative insomnia, who were treated with TJ-54, did not have a higher incidence of postoperative delirium, compared to those without preoperative insomnia. The patients who had a history of delirium have an increased risk of postoperative delirium and should be cared for and treated prophylactically to prevent it.

Keywords: Delirium rating scale – Japanese version; Pancreatic surgery; Postoperative delirium; Yokukansan (TJ-54).

MeSH terms

  • Adenocarcinoma / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Central Nervous System Agents / therapeutic use*
  • Delirium* / epidemiology
  • Delirium* / etiology
  • Delirium* / prevention & control
  • Drugs, Chinese Herbal / therapeutic use*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pancreatectomy*
  • Pancreatic Neoplasms / surgery
  • Pancreaticoduodenectomy*
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Postoperative Complications* / prevention & control
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome

Substances

  • Central Nervous System Agents
  • Drugs, Chinese Herbal
  • Yi-Gan San