{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:15:24Z","timestamp":1788434124352,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T00:00:00Z","timestamp":1769299200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T00:00:00Z","timestamp":1769299200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Postoperative delirium in elderly patients is a critical clinical issue because of its adverse effect on recovery and prognosis. The National Clinical Database (NCD) Risk Calculator, a clinical tool developed in Japan, is widely used to predict various postoperative complications, including delirium. In this study, we aimed to develop a more accurate delirium prediction model by integrating the NCD Risk Calculator with additional clinical indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included 106 patients who underwent segmentectomy or more extensive procedures for hepatocellular carcinoma between 2013 and 2023. The training cohort comprised patients treated between 2013 and 2017, and those treated afterward formed the validation cohort. In the training cohort, we assessed the NCD Risk Calculator and additional indices for the favorable\u2010risk group, and validated the best\u2010performing index in combination with the NCD Risk Calculator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Using the median predicted risk (6.4%) as a threshold, the adverse\u2010risk group had a significantly higher incidence of delirium than the favorable\u2010risk group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Among several indices, the 5\u2010Item Modified Frailty Index (mFI\u20105) showed the strongest association with delirium (AUC 0.76,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Patients classified as high\u2010risk by both the NCD Risk Calculator and mFI\u20105 had significantly higher delirium incidence in the training (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) and validation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05) cohorts. Multivariate analysis identified high\u2010risk status as an independent predictor of postoperative delirium (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The combination of the NCD Risk Calculator and mFI\u20105 enhances predictive accuracy and serves as a reliable tool for assessing delirium risk in older patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ags3.70185","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T06:28:36Z","timestamp":1769408916000},"page":"1174-1182","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The National Clinical Database Risk Calculator and the 5\u2010Item Modified Frailty Index Predict the Development of Postoperative Delirium After Surgery for Hepatocellular Carcinoma"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6928-3676","authenticated-orcid":false,"given":"Kiyotaka","family":"Hosoda","sequence":"first","affiliation":[{"name":"Division of Gastroenterological, Hepato\u2010Biliary\u2010Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine  Matsumoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5015-1697","authenticated-orcid":false,"given":"Akira","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterological, Hepato\u2010Biliary\u2010Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine  Matsumoto 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Hepato\u2010Biliary\u2010Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine  Matsumoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Yoshikawa","sequence":"additional","affiliation":[{"name":"Division of Gastroenterological, Hepato\u2010Biliary\u2010Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine  Matsumoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiko","family":"Ikehara","sequence":"additional","affiliation":[{"name":"Division of Gastroenterological, Hepato\u2010Biliary\u2010Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine  Matsumoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikaru","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterological, 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