# Association of Postoperative Delirium and Perioperative Factors With Frailty in Laparoscopic Gastrointestinal Surgery: A Retrospective Observational Study

## TL;DR

This study found that frail elderly patients undergoing gastrointestinal surgery are more likely to experience delirium and other complications due to factors like age and hospital stay length.

## Contribution

The study identifies specific perioperative factors linked to frailty and delirium in elderly patients undergoing laparoscopic surgery.

## Key findings

- Frail patients had higher rates of postoperative delirium and pain compared to non-frail patients.
- Advanced age, longer hospital stays, and higher ASA scores were significantly associated with frailty.
- Physical restraints and increased DST positivity were linked to frailty in surgical patients.

## Abstract

Background: In the current era of advancing population aging, perioperative management of elderly patients has become a crucial challenge. Frailty is recognized as a condition associated with poor postoperative outcomes, and, particularly, postoperative delirium is an urgent issue for healthcare settings as a major complication in elderly patients. Currently, there is no established international standard for assessing frailty; thus, further understanding in this field is required.

Objective: This study aimed to elucidate the association between preoperative frailty and the incidence of postoperative delirium and pain in patients undergoing gastrointestinal laparoscopic surgery.

Methods: Patients aged 70 years and older who underwent gastrointestinal laparoscopic surgery between July 2019 and May 2022 were assessed using the clinical frailty scale (CFS). Based on the CFS score, participants were categorized into two groups: non-frail (CFS≤3) and frail (CFS≥4). Statistical analyses were conducted to compare outcomes between the groups.

Results: A total of 323 cases were analyzed, comprising 228 patients in the non-frail group and 95 in the frail group. Logistic regression analysis was performed for variables that showed significant differences. In univariate analysis, significant differences were found in six items: age, length of hospital stay, ASA Physical Status Classification (ASA-PS), presence of physical restraint, postoperative delirium screening tool (DST), and postoperative pain. Multivariate analysis confirmed that all six variables remained significantly associated.

Conclusion: Among frail patients undergoing gastrointestinal laparoscopic surgery, key perioperative factors associated with frailty included advanced age, prolonged hospitalization, higher ASA-PS scores, use of physical restraints, increased DST positivity rates postoperatively, and greater postoperative pain. Each of these factors is a potential contributor to delirium, suggesting that frail individuals are at heightened risk of developing delirium due to these associated variables.