Abstract:

Objective To investigate the incidence and risk factors of postoperative delirium(POD)after free flap reconstruction in patients with oral cavity cancer(OCC) and explore the correlation between prognostic nutritional index(PNI) and system immune inflammation index(SII) with POD in oral cavity cancer patients. Methods A retrospective analysis of 138 patients who underwent the free flap surgery for OCC in Xuzhou Central Hospital between January 2016 to March 2023 were performed. Eighty-nine were male and 49 were female. The average age was (60.04±10.89) years(range: 27 to 88). POD-related risk factors were analyzed with SPSS 26.0 software package. The association between risk factors and POD was analyzed by binary Logistic regression analysis. The effect of PNI and SII was evaluated using the area under the receiver operating characteristic curve(AUC-ROC), sensitivity and specificity. Results A total of 15(10.9%)patients had POD. Single factor analysis results indicated that delirium was associated with age≥60,PNI,SII,total protein, time of operation,tracheostomy, blood transfusion, sleep disturbance, ICU observation time, visual analogue scale(VAS)pain score and complications. Multiple Logistic regression analysis showed that the independent risk factors of delirium included age≥60, PNI, SII, blood transfusion, sleep disturbance and pain. The risk of POD was increased when PNI<50.075 and SII>754.308. AUC of the PNI&SII-prediction model was 0.919; Youden index was 0.689; sensitivity was 0.933 and specificity was 0.756. Conclusion PNI and SII are independent risk factors for POD and can be used as indicators to predict POD. The PNI&SII-prediction model has a good value for POD in patients with flaps for OCC, and can be used to clinically guide early intervention and treatment.

Key words: oral cavity cancer, delirium, prognostic nutritional index, system immune inflammation index, prediction model