Effects of preoperative neoadjuvant chemotherapy on postoperative delirium in patients with gynecological tumor surgery: an observational study.

Purpose: To investigate whether neoadjuvant chemotherapy (NACT) increases the incidence of postoperative delirium (POD) in patients with gynecological tumors undergoing radical hysterectomy.

Methods: This study included 60 patients in the neoadjuvant chemotherapy exposure group and 60 in the non-exposure group. Preoperative cognitive function, the incidence of POD and other physiological parameters were assessed on preoperative day 1 (POD-1), postoperative day 1 (POD1), postoperative day 2 (POD2), and postoperative day 3 (POD3). Additionally, preoperative olfactory function was evaluated using an olfactory detection kit on POD-1. The primary outcome was the incidence of POD within three days after surgery.

Results: The incidence of POD was 28.33% in the exposed group and 8.33% in the non-exposed group (P = 0.005). Compared to the non-exposed group, the exposed group had a higher rate of cognitive dysfunction (33.33% vs 13.33%; P = 0.010), and a higher rate of olfactory dysfunction (OD) (25.00% vs 10.00%; P = 0.031). A restricted cubic spline analysis revealed a non-linear relationship between olfactory test scores and Montreal Cognitive Assessment Scale (MoCA) scores (P for overall < 0.001, P for nonlinear = 0.001). Logistic regression identified NACT, mild and moderate cognitive dysfunction, OD, and depression as independent risk factors for POD, with all factors showing significant associations (P < 0.05). The area under the curve (AUC) of OD for predicting POD was 0.783 (95%CI 0.656-0.909).

Conclusions: This single-blind observational study suggests that NACT increases the incidence of POD in patients with gynecological tumors undergoing radical hysterectomy. Moreover, the results indicate that preoperative OD may reflect preoperative cognitive dysfunction, and have predictive value for the incidence of POD.