Relationship between tumor grade and postoperative delirium in adult patients with glioma

Objective To analyze the incidence and risk factors of postoperative delirium (POD) in patients with glioma and to explore the association between WHO (World Health Organization) tumor grades and POD. Methods A second analysis of clinical data from 113 adult glioma patients in a single-center, prospective cohort study of 800 neurosurgery patients was conducted from March 2017 to February 2018 at Department of Critical Medicine (ICU), Beijing Tiantan Hospital, Capital Medical University. Patients were assessed for delirium on the first to third days post surgery (twice a day) using the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU). The patient was divided into delirium group (43 cases) and non-delirium group (70 cases) by whether the patient had had delirium. We collected the patient’s general preoperative information, preoperative condition, early postoperative clinical data, and neurosurgical specialty data (including WHO grades) as potential risk factors that may be associated with the occurrence of POD. The independent risk factors of POD were identified using multivariate logistic regression analysis. In particular, the relationship between WHO glioma grade and POD was explored. Results In 113 glioma patients who were admitted to the ICU for routine postoperative monitoring, the incidence of POD was 38.1% (43/113). The incidence of POD in patients with WHO grade Ⅰ-Ⅳ gliomas increased with the increase of the WHO grade: 7.7% (1/13), 14.3% (3/21), 22.7% (5/22) and 63.0% (34/57). Among the potential risk factors, age (OR=1.08, 95% CI: 1.04-1.13, P<0.001), GCS (Glasgow coma scale) score at admission to ICU (OR=0.80, 95% CI: 0.71-0.90, P<0.001) and the WHO grade of tumor (OR=2.01, 95% CI: 1.03-3.92, P=0.041) was independent risk factors for POD. Conclusions The WHO grade of glioma is an independent risk factor for POD. With the increase of tumor grade, the incidence of POD also increases. Key words: Glioma; Neurosurgical procedures; Delirium; Neoplasm grading; Compensa-tory neuroplasticity