Abstract:

Objective To investigate the independent risk factors for postoperative delirium (POD) in patients undergoing laparoscopic radical gastrectomy under general anesthesia, and to construct a multifactorial combined prediction model to evaluate its diagnostic performance. Methods A total of 310 patients who underwent laparoscopic radical gastrectomy under general anesthesia were consecutively enrolled and divided into the POD group (n=78) and the non-POD group (n=232) according to whether POD occurred. Univariate analysis and multivariate Logistic regression analysis were used to screen for factors influencing POD. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of each factor, and the area under the curve (AUC) was calculated. The predictive performance of the multifactorial combined model was also compared and assessed. Results Compared with the non-POD group, patients in the POD group were older, had higher CO₂ pneumoperitoneum pressure, higher incidence of intraoperative hypoxemia and hypotension, higher proportion of sleep disturbance, higher proportion of excessively deep anesthesia and lower hemoglobin levels (all P<0.05). Multivariate Logistic regression analysis showed that advanced age (OR=1.112, 95%CI: 1.040-1.188), excessively high CO₂ pneumoperitoneum pressure (OR=10.967, 95%CI: 4.580-16.260), intraoperative hypoxemia (OR=15.243, 95%CI: 5.564-20.676), intraoperative hypotension (OR=12.481, 95%CI: 2.812-25.388), sleep disturbance (OR =8.166, 95%CI: 2.530-26.352) and excessively deep anesthesia (OR =3.320, 95%CI: 1.135-9.645) were independent risk factors for POD, whereas higher hemoglobin level was a protective factor (OR =0.738, 95%CI: 0.652-0.834) (all P<0.05). According to the characteristics of these seven factors, patients were categorized into three groups: baseline physiological factors (age + hemoglobin), intraoperative physiological abnormalities (intraoperative hypoxemia + intraoperative hypotension+ CO₂ pneumoperitoneum pressure) and intervention-related factors (excessively deep anesthesia + sleep disturbance). The diagnostic performance ranked as follows: intraoperative physiological abnormalities (AUC=0.945, 95%CI: 0.908-0.968), baseline physiological factors (AUC=0.892, 95%CI: 0.838-0.926) and intervention-related factors (AUC=0.769, 95%CI: 0.713-0.838). Conclusion Stratified assessment of risk factors based on POD is helpful for the early identification of POD and provides evidence-based guidance for clinical interventions.

Key words: stomach neoplasms, laparoscopy, anesthesia, general, delirious speech, root cause analysis