Incidence and Risk Factors for Postoperative Delirium Following Robotic and Video-Assisted Pulmonary Lobectomy: Analysis of the Nationwide Inpatient Sample, 2005–2020

Background: Postoperative delirium (POD) is a critical yet underrecognized complication following pulmonary lobectomy, particularly in older adults. While robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) offer advantages over open thoracotomy, their impact on POD is uncertain. This study aimed to determine the incidence and risk factors of POD following RATS or VATS pulmonary lobectomies. Methods: This retrospective study analyzed data from patients aged ≥ 50 years who underwent RATS or VATS lobectomies for lung cancer using the Nationwide Inpatient Sample (2005– 2020). POD was identified using International Classification of Diseases (ICD) codes. Logistic regression was used to assess associations between patient demographics, comorbidities, perioperative complications, and POD risk. Results: Among 35,853 patients (mean age: 68.8 years; 55.9% female), 1.7% developed POD. POD risk was similar between patients receiving RATS and VATS. Key risk factors for POD included advanced age (RATS: adjusted odds ratio [aOR]=1.05, 95% confidence interval [CI]: 1.04– 1.07; VATS: aOR=1.08, 95% CI: 1.06– 1.09), pneumonia (RATS: aOR=2.23, 95% CI: 1.36– 3.66; VATS: aOR=2.77, 95% CI: 1.98– 3.86), and infection. Other factors associated with POD were persistent anemia, moderate/severe renal disease, and mechanical ventilation. Conclusion: POD risk was similar between RATS and VATS pulmonary lobectomies and was associated with several patient-related and perioperative factors. These findings may help inform perioperative risk assessment and postoperative monitoring in older adults undergoing minimally invasive pulmonary lobectomy. Keywords: postoperative delirium, nationwide inpatient sample, pulmonary lobectomy, robotic-assisted thoracoscopy, video-assisted thoracoscopy