{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:09:20Z","timestamp":1777388960190,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T00:00:00Z","timestamp":1667952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Else Kr\u00f6ner-Fresenius-Stiftung"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Postoperative delirium (POD) is an acute and serious complication following extended surgery. The aim of this study was to identify possible risk factors and scores associated with POD in patients undergoing reconstructive head and neck surgery. A collective of 225 patients was retrospectively evaluated after receiving reconstructive surgery in the head and neck region, between 2013 to 2018. The incidence of POD was examined with regards to distinct patient-specific clinical as well as perioperative parameters. Uni- and multivariate statistics were performed for data analysis. POD occurred in 49 patients (21.8%) and was strongly associated with an increased age-adjusted Charlson Comorbidity Index (ACCI) and a prolonged stay in the ICU (p = 0.009 and p = 0.000, respectively). Analogous, binary logistic regression analysis revealed time in the ICU (p &lt; 0.001), an increased ACCI (p = 0.022) and a Nutritional Risk Screening (NRS) score \u2260 0 (p = 0.005) as significant predictors for a diagnosis of POD. In contrast, the extent of reconstructive surgery in terms of parameters such as type of transplant or duration of surgery did not correlate with the occurrence of POD. The extension of reconstructive interventions in the head and neck region is not decisive for the development of postoperative delirium, whereas patient-specific parameters such as age and comorbidities, as well as nutritional parameters, represent predictors of POD occurrence.<\/jats:p>","DOI":"10.3390\/jcm11226630","type":"journal-article","created":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T02:44:32Z","timestamp":1667961872000},"page":"6630","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Postoperative Delirium after Reconstructive Surgery in the Head and Neck Region"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9733-3703","authenticated-orcid":false,"given":"Juergen","family":"Taxis","sequence":"first","affiliation":[{"name":"Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strau\u00df-Allee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steffen","family":"Spoerl","sequence":"additional","affiliation":[{"name":"Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strau\u00df-Allee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Broszio","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hospital of the University of Regensburg, Franz-Josef-Strau\u00df-Allee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas","family":"Eichberger","sequence":"additional","affiliation":[{"name":"Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strau\u00df-Allee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1707-7763","authenticated-orcid":false,"given":"Elisabeth","family":"Grau","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Leipzig University Medical Center, Liebigstra\u00dfe 12, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3973-2474","authenticated-orcid":false,"given":"Johannes","family":"Schuderer","sequence":"additional","affiliation":[{"name":"Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strau\u00df-Allee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5561-2184","authenticated-orcid":false,"given":"Nils","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strau\u00df-Allee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Gottsauner","sequence":"additional","affiliation":[{"name":"Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strau\u00df-Allee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-7580","authenticated-orcid":false,"given":"Gerrit","family":"Spanier","sequence":"additional","affiliation":[{"name":"Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strau\u00df-Allee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annika","family":"Bundscherer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hospital of the University of Regensburg, Franz-Josef-Strau\u00df-Allee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Torsten E.","family":"Reichert","sequence":"additional","affiliation":[{"name":"Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strau\u00df-Allee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Ettl","sequence":"additional","affiliation":[{"name":"Department of Cranio- and Maxillofacial Surgery, Hospital of the University of Regensburg, Franz-Josef-Strau\u00df-Allee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying confusion: The confusion assessment method. A new method for detection of delirium","volume":"113","author":"Inouye","year":"1990","journal-title":"Ann Intern Med"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5, American Psychiatric Publishing. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1080\/09540260802675460","article-title":"Motor subtypes of delirium: Past, present and future","volume":"21","author":"Meagher","year":"2009","journal-title":"Int. Rev. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1176\/jnp.12.1.51","article-title":"Relationship between symptoms and motoric subtype of delirium","volume":"12","author":"Meagher","year":"2000","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1001\/archsurg.2011.14","article-title":"Motor subtypes of postoperative delirium in older adults","volume":"146","author":"Robinson","year":"2011","journal-title":"Arch. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1093\/jjco\/hyx029","article-title":"Risk factors for postoperative delirium in patients undergoing major head and neck cancer surgery: A meta-analysis","volume":"47","author":"Zhu","year":"2017","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1001\/jamaoto.2018.3820","article-title":"Risk Factors Associated With Postoperative Delirium in Patients Undergoing Head and Neck Free Flap Reconstruction","volume":"145","author":"Densky","year":"2019","journal-title":"JAMA Otolaryngol. Head. Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1016\/j.lpm.2018.03.012","article-title":"Postoperative delirium","volume":"47","author":"Rengel","year":"2018","journal-title":"Presse Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S241","DOI":"10.1111\/j.1532-5415.2011.03671.x","article-title":"The importance of delirium: Economic and societal costs","volume":"59","author":"Leslie","year":"2011","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.1007\/s00134-007-0687-y","article-title":"Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients","volume":"33","author":"Pandharipande","year":"2007","journal-title":"Intensive Care Med."},{"key":"ref_11","first-page":"34","article-title":"Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients","volume":"65","author":"Pandharipande","year":"2008","journal-title":"J. Trauma"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.bja.2020.06.063","article-title":"Postoperative delirium: Perioperative assessment, risk reduction, and management","volume":"125","author":"Jin","year":"2020","journal-title":"Br. J. Anaesth"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4","DOI":"10.4097\/kja.d.18.00073.1","article-title":"Postoperative delirium","volume":"72","author":"Oh","year":"2019","journal-title":"Korean J. Anesthesiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2591","DOI":"10.1016\/j.joms.2014.07.025","article-title":"Postoperative delirium in head and neck cancer patients: A survey of oncologic oral and maxillofacial surgeon practices","volume":"72","author":"Montes","year":"2014","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2467","DOI":"10.1001\/archinte.161.20.2467","article-title":"Nurses\u2019 recognition of delirium and its symptoms: Comparison of nurse and researcher ratings","volume":"161","author":"Inouye","year":"2001","journal-title":"Arch. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1001\/archoto.2011.1456","article-title":"Alcohol-related predictors of delirium after major head and neck cancer surgery","volume":"138","author":"Shah","year":"2012","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/j.jcms.2016.04.032","article-title":"Incidence and risk factors for postoperative delirium after major head and neck cancer surgery","volume":"44","author":"Booka","year":"2016","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"880092","DOI":"10.3389\/fsurg.2022.880092","article-title":"Early Ambulation to Prevent Delirium After Long-Time Head and Neck Cancer Surgery","volume":"9","author":"Kim","year":"2022","journal-title":"Front. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.joms.2021.08.153","article-title":"Factors Associated With Postoperative Delirium in Patients Undergoing Complex Head and Neck Flap Surgery","volume":"80","author":"Kolk","year":"2022","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.ijom.2004.03.005","article-title":"Risk factors for postoperative delirium in patients undergoing head and neck cancer surgery","volume":"34","author":"Yamagata","year":"2005","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic. Dis."},{"key":"ref_22","unstructured":"(2022, September 15). Deutsche Gesellschaft f\u00fcr Anaesthesiologie und Intensivmedizin e.V., Deutsche Interdisziplinaere Vereinigung f\u00fcr Intensiv- und Notfallmedizin e.V. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. Available online: https:\/\/www.awmf.org\/uploads\/tx_szleitlinien\/001-012l_S3_Analgesie-Sedierung-Delirmanagement-in-der-Intensivmedizin-DAS_2021-08.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/2110-5820-2-49","article-title":"Delirium in the ICU: An overview","volume":"2","author":"Cavallazzi","year":"2012","journal-title":"Ann. Intensive Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1001\/jama.2012.304","article-title":"Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: Two randomized controlled trials","volume":"307","author":"Jakob","year":"2012","journal-title":"JAMA"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e65","DOI":"10.1097\/MLR.0b013e318297429c","article-title":"Why Summary Comorbidity Measures Such As the Charlson Comorbidity Index and Elixhauser Score Work","volume":"53","author":"Austin","year":"2015","journal-title":"Med. Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S0895-4356(02)00585-1","article-title":"How to measure comorbidity. a critical review of available methods","volume":"56","author":"Beckerman","year":"2003","journal-title":"J. Clin. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1097\/00005537-199711000-00009","article-title":"Validation of the Charlson comorbidity index in patients with head and neck cancer: A multi-institutional study","volume":"107","author":"Singh","year":"1997","journal-title":"Laryngoscope"},{"key":"ref_28","first-page":"188","article-title":"Charlson Comorbidity Index: ICD-9 Update and ICD-10 Translation","volume":"12","author":"Glasheen","year":"2019","journal-title":"Am. Health Drug Benefits"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"224","DOI":"10.4103\/0974-2700.161658","article-title":"Comorbidity polypharmacy score and its clinical utility: A pragmatic practitioner\u2019s perspective","volume":"8","author":"Stawicki","year":"2015","journal-title":"J. Emerg. Trauma Shock"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1097\/MLR.0b013e31819432e5","article-title":"A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data","volume":"47","author":"Austin","year":"2009","journal-title":"Med. Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/j.jvs.2017.03.439","article-title":"Risk factors for postoperative delirium in patients undergoing vascular surgery","volume":"66","author":"Galyfos","year":"2017","journal-title":"J. Vasc. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/BSD.0000000000000467","article-title":"Prevention and Management of Postoperative Delirium in Elderly Patients Following Elective Spinal Surgery","volume":"30","author":"Nazemi","year":"2017","journal-title":"Clin. Spine Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/22\/6630\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:12:52Z","timestamp":1760145172000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/22\/6630"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,9]]},"references-count":32,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["jcm11226630"],"URL":"https:\/\/doi.org\/10.3390\/jcm11226630","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,9]]}}}