Delirium, Frailty, and Fast-Track Surgery in Oncogeriatrics: Is There a Link?

Fiammetta Monacelli, Alessio Signori, Matteo Prefumo, Chiara Giannotti, Alessio Nencioni, Emanuele Romairone, Stefano Scabini, Patrizio Odetti

Research output: Contribution to journalArticle

Abstract

Background/Aims: Postoperative delirium (POD) is more frequent in elderly patients undergoing major cancer surgery. The interplay between individual clinical vulnerability and a series of perioperative factors seems to play a relevant role. Surgery is the first-line treatment option for cancer, and fast-track surgery (FTS) has been documented to decrease postoperative complications. The study sought to assess, after comprehensive geriatric assessment (CGA) and frailty stratification (Rockwood 40 items index), which perioperative parameters were predictive of POD development in elderly patients undergoing FTS for colorectal cancer. Methods: A total of 107 consecutive subjects admitted for elective colorectal FTS were enrolled. All patients underwent CGA, frailly stratification, Timed up & go (TUG) test, 4AT test for delirium screening, anesthesiologists physical status classification, and Dindo-Clavien classification. Results: The incidence of POD was 12.3%. Patients’ prevalent clinical phenotype was pre-frail. The multivariate analysis indicated physical performance (TUG in seconds) as the most significant predictor of POD for each second of increase. Conclusions: Only few procedure-specific studies have examined the impact of FTS for colorectal cancer on POD. This is the first study to investigate the risk factors for POD, in a vulnerable octogenarian oncogeriatric population submitted to FTS surgery and frailty stratification.

Original languageEnglish
Pages (from-to)33-41
Number of pages9
JournalDementia and Geriatric Cognitive Disorders Extra
DOIs
Publication statusAccepted/In press - Feb 7 2018

Keywords

  • Delirium
  • Functional impairment
  • Geriatrics
  • Neuroinflammatory aspects of dementia and delirium

ASJC Scopus subject areas

  • Cognitive Neuroscience
  • Psychiatry and Mental health

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  • Cite this

    Monacelli, F., Signori, A., Prefumo, M., Giannotti, C., Nencioni, A., Romairone, E., Scabini, S., & Odetti, P. (Accepted/In press). Delirium, Frailty, and Fast-Track Surgery in Oncogeriatrics: Is There a Link? Dementia and Geriatric Cognitive Disorders Extra, 33-41. https://doi.org/10.1159/000486519