Download PDF
Thorac Cardiovasc Surg
DOI: 10.1055/a-2561-8604
Original Thoracic

Predicting the Risk of Postoperative Delirium in Patients Undergoing Lobectomy: Development and Assessment of a Novel Nomogram

Yanan Xue
1   Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, People's Republic of China
,
Ru Yu
1   Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, People's Republic of China
,
Wei Wang
2   Department of Thoracic Surgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, People's Republic of China
,
Lei Li
3   Department of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, People's Republic of China
,
Jing Tao
1   Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, People's Republic of China
,
Qin Zhuang
1   Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, People's Republic of China
,
Xiaohong Li
1   Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, People's Republic of China
,
Yang Zhang
1   Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, People's Republic of China
› Author Affiliations Funding This work was supported by the Key Natural Science Research Project of Anhui Province (grant number: 2023AH051993) and Key Natural Science Project of Bengbu Medical University (grant number: 2023byzd097).
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Objective

To construct and internally validate a nomogram predicting postoperative delirium (POD) in patients with pulmonary malignancies undergoing lobectomy.

Methods

Clinical electronic medical record data were retrospectively collected from 1,066 patients who underwent lobectomy, divided into a training cohort (746) and a validation cohort (320) using a 7:3 temporal split. A nomogram for POD was developed using Lasso regression and multivariable logistic regression analysis according to the TRIPOD statement. Performance was assessed through receiver operating characteristic curves (ROC) and calibration plots.

Results

POD occurred in 203 patients (19.04%). The nomogram incorporated predictors such as age, body mass index (BMI), education level, history of diabetes, history of cerebrovascular disease, surgical approach, duration of surgery, and time to recovery from anesthesia. The area under the ROC curve (AUC) was 0.871 (95% confidence interval [CI]: 0.841–0.901) for the training cohort and 0.914 (95% CI: 0.877–0.951) for the validation cohort. Calibration curves demonstrated good agreement between predicted and actual probabilities in both cohorts.

Conclusion

This novel nomogram can help clinicians and patients' families predict the likelihood of developing delirium following lobectomy, enabling the implementation of targeted prevention strategies.

Keywords

delirium - postoperative - pneumonectomy - nomograms - risk factors - logistic models

Ethical Approval Statement

This study adhered to the principles outlined in the Declaration of Helsinki and obtained ethical approval from the Clinical Research Ethics Committee of the First Affiliated Hospital of Bengbu Medical University (approval number: 2023YJS210).


Authors' Contribution

Z.Y. designed the project. X.Y.N. and Y.R. were involved in data collection and analysis, manuscript drafting, and reviewing. W.W. provided expertise in surgical content and designed the manuscript. L.L. provided expertise in neuropsychology. T.J. and Z.Q. were responsible for manuscript preparation. L.X.H. provided expertise in anesthesiology, guided the data collection, performed the data analysis, and participated in drafting and reviewing the manuscript. All authors approved the final version of the manuscript.


Supplementary Material



Publication History

Received: 18 October 2024

Accepted: 14 March 2025

Article published online:
18 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Leiter A, Veluswamy RR, Wisnivesky JP. The global burden of lung cancer: current status and future trends. Nat Rev Clin Oncol 2023; 20 (09) 624-639
    PubMedSearch in Google Scholar
  • 2 Ahuja J, de Groot PM, Shroff GS. et al. The postoperative chest in lung cancer. Clin Radiol 2022; 77 (01) 6-18
    PubMedSearch in Google Scholar
  • 3 Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth 2020; 125 (04) 492-504
    CrossrefPubMedSearch in Google Scholar
  • 4 Katayama ES, Stecko H, Woldesenbet S. et al. The role of delirium on short- and long-term postoperative outcomes following major gastrointestinal surgery for cancer. Ann Surg Oncol 2024; 31 (08) 5232-5239
    PubMedSearch in Google Scholar
  • 5 Szylińska A, Rotter I, Listewnik M. et al. Postoperative delirium in patients with chronic obstructive pulmonary disease after coronary artery bypass grafting. Medicina (Kaunas) 2020; 56 (07) 342
    PubMedSearch in Google Scholar
  • 6 Collins GS, Reitsma JB, Altman DG, Moons KG. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ 2015; 350: g7594
    CrossrefPubMedSearch in Google Scholar
  • 7 Blazer DG, van Nieuwenhuizen AO. Evidence for the diagnostic criteria of delirium: an update. Curr Opin Psychiatry 2012; 25 (03) 239-243
    PubMedSearch in Google Scholar
  • 8 Xiang D, Xing H, Zhu Y. A predictive nomogram model for postoperative delirium in elderly patients following laparoscopic surgery for gynecologic cancers. Support Care Cancer 2022; 31 (01) 24
    PubMedSearch in Google Scholar
  • 9 Chen J, Ji X, Xing H. Risk factors and a nomogram model for postoperative delirium in elderly gastric cancer patients after laparoscopic gastrectomy. World J Surg Oncol 2022; 20 (01) 319
    PubMedSearch in Google Scholar
  • 10 Luo YG, Wu XD, Song YX. et al. Development and validation of a nomogram to predict postoperative delirium in older patients after major abdominal surgery: a retrospective case-control study. Perioper Med (Lond) 2024; 13 (01) 41
    PubMedSearch in Google Scholar
  • 11 Murakawa K, Kitamura Y, Watanabe S, Hongo S, Shinomiya K, Sendo T. Clinical risk factors associated with postoperative delirium and evaluation of delirium management and assessment team in lung and esophageal cancer patients. J Pharm Health Care Sci 2015; 1: 4
    PubMedSearch in Google Scholar
  • 12 Sun Z. Postoperative delirium in geriatric patients with thoracic and orthopedic surgery. J Clin Anesth 2024; 94: 111399
    PubMedSearch in Google Scholar
  • 13 Swarbrick CJ, Partridge JSL. Evidence-based strategies to reduce the incidence of postoperative delirium: a narrative review. Anaesthesia 2022; 77 (Suppl. 01) 92-101
    PubMedSearch in Google Scholar
  • 14 Tasbihgou SR, Absalom AR. Postoperative neurocognitive disorders. Korean J Anesthesiol 2021; 74 (01) 15-22
    PubMedSearch in Google Scholar
  • 15 Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in older persons: advances in diagnosis and treatment. JAMA 2017; 318 (12) 1161-1174
    CrossrefPubMedSearch in Google Scholar
  • 16 Liang F, Baldyga K, Quan Q. et al. Preoperative plasma Tau-PT217 and Tau-PT181 are associated with postoperative delirium. Ann Surg 2023; 277 (06) e1232-e1238
    CrossrefPubMedSearch in Google Scholar
  • 17 Brown CH, Lewis A, Probert J. et al. Perioperative neurofilament light plasma concentrations and cognition before and after cardiac surgery: a prospective nested cohort study. Anesthesiology 2022; 137 (03) 303-314
    PubMedSearch in Google Scholar
  • 18 Chen K, Hu Q, Gupta R, Stephens J, Xie Z, Yang G. Inhibition of unfolded protein response prevents post-anesthesia neuronal hyperactivity and synapse loss in aged mice. Aging Cell 2022; 21 (04) e13592
    PubMedSearch in Google Scholar
  • 19 Zhou Y, Ju H, Hu Y. et al. Tregs dysfunction aggravates postoperative cognitive impairment in aged mice. J Neuroinflammation 2023; 20 (01) 75
    PubMedSearch in Google Scholar
  • 20 Callan KT, Donnelly M, Lung B. et al. Risk factors for postoperative delirium in orthopaedic hip surgery patients: a database review. BMC Musculoskelet Disord 2024; 25 (01) 71
    PubMedSearch in Google Scholar
  • 21 Deng X, Qin P, Lin Y. et al. The relationship between body mass index and postoperative delirium. Brain Behav 2022; 12 (04) e2534
    PubMedSearch in Google Scholar
  • 22 Feinkohl I, Janke J, Slooter AJC, Winterer G, Spies C, Pischon T. BioCog Consortium. Metabolic syndrome and the risk of postoperative delirium and postoperative cognitive dysfunction: a multi-centre cohort study. Br J Anaesth 2023; 131 (02) 338-347
    PubMedSearch in Google Scholar
  • 23 Gracie TJ, Caufield-Noll C, Wang NY, Sieber FE. The association of preoperative frailty and postoperative delirium: a meta-analysis. Anesth Analg 2021; 133 (02) 314-323
    CrossrefPubMedSearch in Google Scholar
  • 24 Ramos J, Chowdhury AR, Caywood LJ. et al. Lower levels of education are associated with cognitive impairment in the old order Amish. J Alzheimers Dis 2021; 79 (01) 451-458
    PubMedSearch in Google Scholar
  • 25 Lövdén M, Fratiglioni L, Glymour MM, Lindenberger U, Tucker-Drob EM. Education and cognitive functioning across the life span. Psychol Sci Public Interest 2020; 21 (01) 6-41
    PubMedSearch in Google Scholar
  • 26 Deeken F, Sánchez A, Rapp MA. et al; PAWEL Study Group. Outcomes of a delirium prevention program in older persons after elective surgery: a stepped-wedge cluster randomized clinical trial. JAMA Surg 2022; 157 (02) e216370
    CrossrefPubMedSearch in Google Scholar
  • 27 Shpakov AO, Zorina II, Derkach KV. Hot spots for the use of intranasal insulin: cerebral ischemia, brain injury, diabetes mellitus, endocrine disorders and postoperative delirium. Int J Mol Sci 2023; 24 (04) 3278
    PubMedSearch in Google Scholar
  • 28 Shang Z, Jiang Y, Fang P. et al. The association of preoperative diabetes with postoperative delirium in older patients undergoing major orthopedic surgery: a prospective matched cohort study. Anesth Analg 2024; 138 (05) 1031-1042
    PubMedSearch in Google Scholar
  • 29 Bramley P, McArthur K, Blayney A, McCullagh I. Risk factors for postoperative delirium: an umbrella review of systematic reviews. Int J Surg 2021; 93: 106063
    CrossrefPubMedSearch in Google Scholar
  • 30 Eertmans W, De Deyne C, Genbrugge C. et al. Association between postoperative delirium and postoperative cerebral oxygen desaturation in older patients after cardiac surgery. Br J Anaesth 2020; 124 (02) 146-153
    PubMedSearch in Google Scholar
  • 31 Dezube AR, Bravo-Iñiguez CE, Yelamanchili N. et al. Risk factors for delirium after esophagectomy. J Surg Oncol 2020; 121 (04) 645-653
    PubMedSearch in Google Scholar
  • 32 Liu X, Wang Y, Wu J, Ye C, Ma D, Wang E. Emergence delirium and postoperative delirium associated with high plasma NfL and GFAP: an observational study. Front Med (Lausanne) 2023; 10: 1107369
    PubMedSearch in Google Scholar
  • 33 Yang KL, Detroyer E, Van Grootven B. et al. Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis. BMC Geriatr 2023; 23 (01) 198
    PubMedSearch in Google Scholar
  • 34 Ding X, Gao X, Chen Q. et al. Preoperative acute pain is associated with postoperative delirium. Pain Med 2021; 22 (01) 15-21
    PubMedSearch in Google Scholar
  • 35 Rodriguez TM, Sheffler P, Ferguson LE, Rebok GW, Wu R. Cognitive and functional improvement via novel skill learning for low-income minoritized middle-aged and older adults. Prev Sci 2023; 24 (05) 926-935
    PubMedSearch in Google Scholar
  • 36 Li L, Huang X, Xiao J. et al. Neural synchronization predicts marital satisfaction. Proc Natl Acad Sci U S A 2022; 119 (34) e2202515119
    CrossrefPubMedSearch in Google Scholar
  • 37 Liu Y, Liu Z, Liang R, Luo Y. The association between community-level socioeconomic status and depressive symptoms among middle-aged and older adults in China. BMC Psychiatry 2022; 22 (01) 297
    PubMedSearch in Google Scholar