Impact of multicomponent, nonpharmacologic interventions on perioperative cortisol and melatonin levels and postoperative delirium in elderly oral cancer patients

Nov 9, 2015Archives of gerontology and geriatrics

Effects of combined non-drug treatments on stress and sleep hormones and delirium after surgery in older oral cancer patients

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Abstract

Postoperative melatonin sulfate levels were higher and cortisol concentrations lower in patients receiving multicomponent nonpharmacologic interventions (MNI).

MNI is associated with improved melatonin sulfate levels in urine after surgery.
Cortisol concentrations in urine were lower in patients who received MNI compared to those who received usual care.
Patients receiving MNI reported better scores on the Richmond Agitation Sedation Scale (RASS) and the quality of recovery (QoR40) scale.
The incidence and duration of postoperative delirium (PD) were reduced in the group receiving MNI.

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OBJECTIVE: To investigate the impact of multicomponent, nonpharmacologic interventions (MNI) on perioperative cortisol and melatonin levels, as well as postoperative delirium (PD), in elderly oral cancer patients.

METHODS: A total of 160 elderly oral cancer patients who underwent tumor resection surgery and completed our investigation were included in this study. The cancer patients were randomly divided into 2 groups: Group U or Group I. During the perioperative period, Group U received usual care, while Group I received MNI, which is based on usual care and aims to decrease the risk of PD. MNI focused on general geriatric approaches and supportive nursing care. On the day before surgery and the first three postoperative days, nocturnal (20:00-8:00) urine samples were collected. The melatonin sulfate and cortisol levels in the urine samples were determined. Moreover, the RASS (Richmond Agitation Sedation Scale), CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) and QoR40 (40-item quality of recovery score) scores were dynamically monitored.

RESULTS: There were no significant differences in the general characteristics between the 2 groups. After surgery, the melatonin sulfate levels in the nocturnal urine of Group I were higher than those in Group U. The cortisol concentrations were lower in Group I compared to those in Group U. Group I achieved better postoperative RASS and QoR40 scores than Group U. Compared to Group U, Group I also experienced less PD (incidence and duration).

CONCLUSIONS: MNI ameliorated some postoperative disturbances regarding sleep and stress, decreased the incidence of PD and improved recovery quality.

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Impact of multicomponent, nonpharmacologic interventions on perioperative cortisol and melatonin levels and postoperative delirium in elderly oral cancer patients

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