Postoperative delirium in plastic or dermatologic surgery

Postoperative delirium is a serious and commonly encountered problem in the field of surgery. But in plastic surgery, this problem is rarely reported. We restrospectively examined the incidence of delirium using the 12-point Delirium Rating Scale in 364 inpatients treated over a 3-year period, whose ages ranged from 56 to 96 years. Surgery for malignant tumors was the most frequent type of surgery. The overall incidence of delirium was 1.4%; but when distributed by disease, patients with extramammary Paget’s disease showed the highest incidence. We then examined the records of patients with extramammary Paget’s disease or carcinoma treated in the ten previous years. The incidence in this group was 20.7%, and all of them were men. The average age of the male patients manifesting delirium was 79.8 years and that of those who did not develop delirium was 73.2 years. As many reports suggest, in our patients, precipitating factors such as physical restraints, bladder catheterization, and risk factors such as old age, seemed to have been strongly related to the occurrence of delirium. In conclusion, postoperative delirium is rarely observed in the field of dermatologic or plastic surgery. In our practice, the incidence of delirium was particularly high in patients with extramammary Paget’s disease, especially in elderly male patients. Close attention must be paid to this subset of patients to prevent delirium.