Decreased Incidence of Postoperative Delirium in Robot-assisted Thoracoscopic Esophagectomy Compared with Open Transthoracic Esophagectomy

Background: Postoperative delirium (POD) is one of messy complications related with increased mortality and hospital costs. Patients undergoing esophagectomy are more in danger of delirium than other kinds of surgeries. We investigated the impact of robot-assisted thoracoscopic esophagectomy on the incidence of POD compared with open transthoracic esophagectomy. Materials and Methods: A retrospective review was completed for the patients who underwent esophagectomy from December 2, 2012 and April 15, 2015 (n=529). POD was assessed using Confusion Assessment Method for the Intensive Care Unit. The comparison of group differences between the robotic esophagectomy group (R group) and the open esophagectomy group (O group) was conducted with and without propensity score (PS) matching method. Univariate model was used for 247 PS-matched patients to calculate the odds ratio of potential risk factors of POD. Results: The incidence rate of POD was significantly lower among R group patients than O group (30% vs. 42%; P=0.035) after PS matching method. The risk of POD in R group was 0.55-fold lower than that of O group. Operative time and intraoperative blood loss were also significantly lower in R group patients. Conclusions: In conclusion, robotic thoracoscopic esophagectomy lowers the incidence of POD 0.55-fold compared with open transthoracic esophagectomy.