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Postoperative Delirium in Major Urologic Surgery: Procedure-Specific Risk Factors and Impact on 30-Day Outcomes
Boyuan Xiao, BA1, Jonathan J. Song, BA1, Nancy G. Donohoo, BA1, Alexander P. Cole, MD2, David S. Wang, MD1.
1Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA, 2Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Introduction The procedural risk factors and outcome impact of postoperative delirium after major urologic surgery remain poorly characterized.
Methods Using ACS-NSQIP (2021-2024), we identified patients undergoing major urologic surgery (prostatectomy, renal/upper tract, bladder oncology, major reconstructive) via CPT coding who underwent delirium screening. Multivariable logistic regression assessed procedure-specific delirium risk and associated 30-day outcomes, adjusting for known delirium-inducing factors and significant univariate predictors.
Results We identified
17,606 patients, of which 766 (4.35%) developed delirium. Bladder oncologic (OR 3.17, 95% CI 2.37-4.29) and renal/upper tract procedures (OR 1.74, 95% CI 1.31-2.33) carried significantly higher delirium risk versus prostatectomy. Delirium was independently associated with increased return to OR (OR 2.63), prolonged stay (+3.55 days), readmission (OR 1.26), transfer to higher care (OR 3.77), functional decline (OR 2.55), and 30-day mortality (OR 3.95; all p<0.05). Of these, only readmission varied by procedure type (p-interaction=0.002), with strongest effects in prostate (OR 3.03, 95% CI 1.59-5.79) and renal/upper tract oncology (OR 1.76, 95% CI 1.28-2.42).
Conclusion In this large database analysis, postoperative delirium affected 4.35% of screened patients and was independently associated with increased risk for subsequent morbidity and mortality. These findings underscore delirium as a consistently high-risk complication across major urologic surgery. The association between delirium and readmission varied by procedure type, supporting the need for procedure-tailored post-discharge surveillance in high-risk groups such as prostate and kidney/upper tract oncology. Future research is needed to improve risk stratification and develop effective strategies for the prevention of postoperative delirium after major urologic surgery.
Multivariate Analysis of Various Risk Factors for Post-Operative Delirium| Risk Factors | OR | 95% CI | p-value |
| Age (5 yrs) | 1.39 | 1.25-1.55* | <0.001* |
| Female Sex (vs Male) | 0.96 | 0.81-1.14 | 0.659 |
| ASA 4-5 (vs 1-2) | 2.35 | 1.72-3.23* | <0.001* |
| Dementia | 5.41 | 4.24-6.86* | <0.001* |
| Fall, within last 6 months | 1.62 | 1.23-2.09* | <0.001* |
| Total Operation Time (30 min) | 1.08 | 1.05-1.10* | <0.001* |
| Kidney and Upper Tract (vs Prostatectomy) | 1.74 | 1.31-2.33* | <0.001* |
| Major Reconstructive (vs Prostatectomy) | 1.10 | 0.60-1.89 | 0.751 |
| Bladder Oncology (vs Prostatectomy) | 3.17 | 2.37-4.29* | <0.001* |
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