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Ramelteon and suvorexant for postoperative delirium in elderly patients with esophageal cancer

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Abstract

Background

There is no clear evidence on the prevention of postoperative delirium with pharmacotherapy in elderly patients with esophageal cancer. This retrospective study aimed to evaluate the efficacy of ramelteon and suvorexant in preventing postoperative delirium in this patient group.

Methods

Data on 251 patients who received radical esophagectomy for thoracic esophageal cancer were collected from January 2010 to September 2021. In total, 74 patients did not receive preventive intervention, and 177 received ramelteon and suvorexant. After propensity score matching, the rate of postoperative delirium was compared between the two groups.

Results

Seventy-two well-balanced patients in each group demonstrated similar clinical and pathological characteristics. The mean ages of the intervention and control groups were 70.8 and 70.3 years, respectively. All the patients underwent McKeown esophagectomy, and in the volume of intraoperative blood loss or operative time did not significantly differ between the two groups. The incidence rates of postoperative hyperactive delirium were 7% (5/72) in the intervention group and 32% (23/72) in the control group (p < 0.001). No severe adverse event potentially attributable to the intervention drug was observed. The multivariate analysis showed that the use of ramelteon and suvorexant was the only independent protective factor against postoperative delirium (hazard ratio 0.157, 95% CI 0.055–0.448, p < 0.001).

Conclusions

Ramelteon and suvorexant may play an important role in reducing postoperative delirium in elderly patients with esophageal cancer.

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Authors and Affiliations

  1. Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, 1004 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Shuhei Mayanagi, Masazumi Inoue, Kenjiro Ishii & Yasuhiro Tsubosa

  2. Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu City , Shizuoka, Japan

    Ryoma Haneda

Authors
  1. Shuhei Mayanagi
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  2. Ryoma Haneda
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  3. Masazumi Inoue
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  4. Kenjiro Ishii
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  5. Yasuhiro Tsubosa
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Corresponding author

Correspondence to Yasuhiro Tsubosa.

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This study was approved by the Institutional Review Board of Shizuoka Cancer Center Hospital (J2022-62-2022-1-3).

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Mayanagi, S., Haneda, R., Inoue, M. et al. Ramelteon and suvorexant for postoperative delirium in elderly patients with esophageal cancer. Esophagus 20, 635–642 (2023). https://doi.org/10.1007/s10388-023-01019-7

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  • DOI: https://doi.org/10.1007/s10388-023-01019-7

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