Post-Operative Delirium in patients with Head and Neck Oral Cancer in the West of Scotland

Abstract Aims To determine the prevalence and association of post-operative delirium (POD) in Head and Neck (H&N) cancer patients undergoing free flap reconstruction at the QEUH OMFS unit. To assess whether these determinants can be modified to optimise patient care and reduce the occurrence of POD. Introduction Delirium remains an important problem in the postoperative care of patients undergoing major H&N surgery. Early detection and management improves overall patient outcomes. Methods Patient database containing details of pre-operative physical status including alcohol misuse, chronic co-morbidity, and physiological status of 1006 patients that underwent major H&N surgery with free flap repair at the QEUH from 2009-2019 was analysed. Factors associated with delirium were studied, identifying univariate associations as well as multivariate modelling to determine independent risk factors. Results Incidence of POD was 7.5% (75/1006). • 53 male: 22 female • average age 65.41 years POD was strongly associated with pre-existing medical comorbidities, excess alcohol, smoking, prolonged surgical operating time (>700 minutes), tracheostomy, blood transfusion and bony free-flaps. Those with POD were at an increased risk of post-operative wound and lung complications. And were more likely to require hospitalisation > 21 days. Conclusion Pre-surgical assessment should identify risk factors, optimising the diagnosis and treatment of POD. This will enhance patient care, by reducing further medical and surgical complications and reducing overall hospital stay.