Hepatic steatosis as a risk factor for postoperative delirium following hepatectomy: a retrospective cohort study.

BACKGROUND: Postoperative delirium (POD) is a common complication following hepatectomy. However, there are no studies on the occurrence of POD in patients with hepatic steatosis undergoing hepatectomy. This study aimed to evaluate the incidence and risk factors for POD in patients with hepatic steatosis after hepatectomy, and investigate the related mechanisms. METHODS: This study was a single-center, retrospective cohort study. Adult patients who underwent hepatectomy at Beijing Tsinghua Changgung Hospital between June 2021 and June 2025 were selected as the study subjects. Patients were divided into two groups: the hepatic steatosis (HS) group and the non-hepatic steatosis (NHS) group. The primary outcome was the incidence of POD, whereas the secondary outcomes included the length of intensive care unit (ICU) stay, total length of stay, and 90-day mortality rate after surgery. Propensity score matching analysis was performed between the two groups. Finally, univariate and multivariable stratified Cox proportional hazards models were used to identify independent risk factors for POD. RESULTS: In the matched cohort, the incidence of POD was significantly greater in the HS group than in the NHS group (16.7% vs. 7.3%, P<0.001). There were no significant differences in the timing, location, or duration of POD between the two groups (P>0.05). The length of ICU stay (P<0.001) and total length of stay (P<0.05) were longer in the HS group than in the NHS group. The 90-day mortality rate was greater in the HS group than in the NHS group, although the difference was not statistically significant (6.3% vs. 2.7%, P=0.053). Multivariable stratified Cox regression analysis revealed that hepatic steatosis (HR: 2.57, 95% CI: 1.29-5.10, P=0.007), age (HR: 1.05, 95% CI: 1.01-1.09, P=0.013), and Child-Pugh class B/C (HR: 3.19, 95% CI: 1.34-7.59, P=0.009) were independent risk factors for the time to POD after hepatectomy. CONCLUSIONS: The incidence of POD was greater in patients with hepatic steatosis than in those without hepatic steatosis after hepatectomy. Whether preoperative optimization of liver status (e.g., a reduction in hepatic steatosis) can reduce the incidence of POD remains to be determined.