(A619) Risk Factors for Postoperative Delirium in Head and Neck Cancer Patients: A Multi-National Database Analysis

Introduction: Postoperative delirium is associated with worse patient outcomes, and there are limited data on specific risk factors following head and neck cancer (HNC) surgery. This study aims to identify the association of key modifiable risk factors on development of postoperative delirium following surgical management of HNC.

Methods: Retrospective cohort database study using TriNetX, a live HIPPA-compliant federated cloud electronic health record research network representing pooled data from 125-million patients from 95 healthcare organizations in the United States, Taiwan, Japan, Brazil, and India. Patients who underwent surgical management for HNC were separated into cohorts by risk factors. Propensity score matching was conducted for age, gender, race, history of dementia, and concurrent use of sedating medications. Odds-ratios with 95% confidence intervals (OR, 95%CI) were calculated for risk of delirium within 7 days after surgery.

Results: There were 42,248 patients identified who received surgical management for HNC. Patients were more likely to develop postoperative delirium with preoperative pharmaceutical management with melatonin (2.827, 2.323-3.580), benzodiazepines (2.175, 1.835-2.577) or antidepressants (1.96, 1.748-2.207). Patients also had an increased risk with an elevated hemoglobin A1c (2.564, 1.138-5.778), alcohol use (2.344, 1.828-3.004), history of dementia (2.431, 1.890-3.126), or previous delirium episodes (12.084, 10.093-14.742).

Conclusions: Preoperative sedating medications, elevated A1c, alcohol use, and prior neurologic disease increase the risk of postoperative delirium in HNC patients. These patients may benefit from preoperative evaluation of concurrent sedating medications and medical optimization to reduce the risk of postoperative delirium.