P1.216. Investigation of Lemborexant for Prevention of Postoperative Delirium Following Subtotal Thoracic Esophagectomy

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background Postoperative delirium and sleep disturbances after surgery for gastrointestinal malignancies greatly affect patients' quality of life. Postoperative delirium in particular has been reported to be associated with prolonged hospitalization and increased postoperative complications. Recently, hypnotics have been used to prevent delirium, and among them the effects of lemborexant are promising. Methods We studied 209 patients (excluding open-thoracotomy cases) who underwent subtotal esophagectomy in our department between April 2019 and March 2024. Patients treated before the introduction of lemborexant were assigned to Group A (n = 91), and those treated after its introduction to Group B (n = 118). We examined whether the introduction of lemborexant affected the incidence of delirium or mid- to long-term outcomes.We retrospectively reviewed medical records and assessed cases for delirium within 7 days postoperatively. Cases were classified as delirium if the physician's chart explicitly documented delirium or if nursing SOAP notes clearly indicated an alteration in consciousness. We also classified cases as delirium if a psychiatrist intervened and provided treatment for delirium. Results Postoperative delirium occurred in Group A 15/91 (16.5%) and Group B 9/118 (7.6%) (P = 0.046). Sex (male/female) was A: 74/17 and B: 107/11 (P = 0.049). Regarding perioperative factors, open abdominal procedures were A: 36/91 (39.6%) and B: 36/118 (30.5%) (P = 0.172). Blood loss was 313.2 ± 354.0 mL in Group A and 213.3 ± 241.3 mL in Group B (P = 0.018). Postoperative length of stay was 31.4 ± 18.2 days in Group A and 27.0 ± 14.8 days in Group B (P < 0.001). Postoperative complications of Clavien–Dindo grade ≥3 were A: 17/91 (18.7%) and B: 21/118 (17.8%) (P = 0.869). Two-year recurrence-free survival was 55.4% (95% CI 45.0–65.8%) in Group A and 65.4% (95% CI 56.6–74.2%) in Group B(P=0.15). Two-year overall survival was 77.2% (95% CI 68.4–86.0%) in Group A and 75.5% (95% CI 67.3–83.7%) in Group B(P=0.78). Conclusion Postoperative delirium is a common and serious complication after highly invasive procedures such as subtotal thoracic esophagectomy. After the introduction of lemborexant, the incidence of delirium decreased significantly. In addition, postoperative length of stay tended to be shorter. Two-year recurrence-free survival was better in Group B, while two-year overall survival did not differ between the groups.