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Risk stratification and predictive modeling of postoperative delirium in chronic subdural hematoma

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Abstract

Background— Postoperative delirium is a common complication associated with the elderly, causing increased morbidity and prolonged hospital stay. However, its risk factors in chronic subdural hematoma patients have not been well studied. Methods— A total of 202 consecutive patients with chronic subdural hematoma at Peking University Third Hospital between January 2018 and January 2023 were enrolled. Various clinical indicators were analyzed to identify independent risk factors for postoperative delirium using univariate and multivariate regression analyses. Delirium risk prediction models were developed as a nomogram and a Markov chain. Results— Out of the 202 patients (age, 71 (IQR, 18); female-to-male ratio, 1:2.7) studied, 63 (31.2%) experienced postoperative delirium. Univariate analysis identified age (p < 0.001), gender (p = 0.014), restraint belt use (p < 0.001), electrolyte imbalance (p < 0.001), visual analog scale score (p < 0.001), hematoma thickness (p < 0.001), midline shift (p < 0.001), hematoma side (p = 0.013), hematoma location (p = 0.018), and urinal catheterization (p = 0.028) as significant factors. Multivariate regression analysis confirmed the significance of restraint belt use (B = 7.657, p < 0.001), electrolyte imbalance (B = -3.993, p = 0.001), visual analog scale score (B = 2.331, p = 0.016), and midline shift (B = 0.335, p = 0.007). Hematoma thickness and age had no significant impact. Conclusion— Increased midline shift and visual analog scale scores, alongside restraint belt use and electrolyte imbalance elevate delirium risk in chronic subdural hematoma surgery. Our prediction models may offer reference value in this context.

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Data availability

Data is available in the following Google Drive link: https://docs.google.com/spreadsheets/d/1REE5j2ukQuR6r-xF4xaKlyyHBou_op1q/edit? usp=sharing&ouid=106659792568686096568&rtpof=true&sd=true.

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Acknowledgements

We extend our deepest gratitude to all the patients who participated in this study, as well as their caretakers, for their invaluable contributions and patience.

Funding

This work was supported by the National Natural Science Foundation of China (82371319 to CY), Beijing Nova Program (20230484356 to CY), Beijing Natural Science Foundation (7222217 to CY), Capital Health Research and Development of Special (2022-4-40918 to CY), the Fundamental Research Funds for the Central Universities (7101503232 to JY and CY), AO Spine Research Start-up Grant (AOS-Startup-21-016 to CY), Peking University Clinical Medicine Plus X-Young Scholars Project (PKU2021LCXQ007 to CY), and Peking University Third Hospital Clinical Key Project (BYSYZD2021023 to CY).

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Author notes

  1. Xuan Yang and Moksada Regmi contributed equally to this work and are considered co-first authors.

Authors and Affiliations

  1. Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China

    Xuan Yang

  2. Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China

    Moksada Regmi, Yingjie Wang, Weihai Liu, Yuwei Dai, Shikun Liu, Guozhong Lin, Jun Yang & Chenlong Yang

  3. Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing, China

    Moksada Regmi, Yingjie Wang, Weihai Liu, Yuwei Dai, Shikun Liu, Guozhong Lin, Jun Yang & Chenlong Yang

  4. Peking University Health Science Center, Beijing, China

    Moksada Regmi, Weihai Liu, Yuwei Dai & Shikun Liu

  5. Peking University School of Economics, Beijing, China

    Jingyi Ye

  6. State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China

    Chenlong Yang

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Contributions

C.Y. and J.Y. conceptualized and designed the study. Y.W., W.L., and Y.D. were responsible for material preparation and data analysis. X.Y. and M.R. drafted the original manuscript. S.L., G.L., and J.Y. reviewed and edited the manuscript. M.R. created Figs. 1, 2 and 3, while X.Y. developed Tables 1, 2 and 3. All authors have read and approved the final manuscript for publication.

Corresponding authors

Correspondence to Jingyi Ye or Chenlong Yang.

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Approval was granted by the Ethics Committee of Peking University Third Hospital.

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Informed consent was obtained from all individual participants included in the study, or their legal representatives.

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Yang, X., Regmi, M., Wang, Y. et al. Risk stratification and predictive modeling of postoperative delirium in chronic subdural hematoma. Neurosurg Rev 47, 152 (2024). https://doi.org/10.1007/s10143-024-02388-y

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