The Prediction of Postoperative Delirium Using the Preoperative Assessments of Frailty and Cognitive Impairment in Aged Patients.

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY Clinical Interventions in Aging Pub Date : 2024-12-10 eCollection Date: 2024-01-01 DOI:10.2147/CIA.S487043

Pengfei Ni, Ziyou Liu, Jia Yang, Yanhu Xie, Sheng Wang

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Abstract

Purpose: Frailty and cognitive impairment are closely associated with postoperative delirium. The purpose of this study was to compare the ability of screening tools assessing preoperative frailty and cognitive impairment to predict Postoperative delirium (POD) and the association with prevalence of postoperative complications, Intensive Care Unit (ICU) admission, and the hospital length of stay.

Patients and methods: Two hundred and ninety-nine patients aged ≥60 years presenting for elective major thoracic or abdominal surgery were divided into preoperative frailty and no frailty groups or cognitive impairment and no cognitive impairment groups. The primary outcome was the incidence of postoperative delirium. The secondary outcomes included postoperative complications, ICU admission, and hospital lengths of stay.

Results: Frailty (25.6% VS 14.6%, P = 0.017) and cognitive impairment (32.7% VS 13.4%, P < 0.001) were associated with POD. However, the area under the receiver operating characteristic curve (AUC-ROC) between frailty (0.657 [95% CI 0.60-0.71]) and cognitive impairment (0.661 [95% CI 0.60-0.71]) for POD was not different (P = 0.9) and both lower than the integrated predictive model of age, body mass index (BMI), American Society of Anesthesiologists (ASA) status, duration of surgery, morphine equivalent, surgical risk, frailty and cognitive impairment (0.814 [95% CI 0.77-0.86], P < 0.0001, P < 0.0001). Besides, frailty (15.6% vs 6.3%, P = 0.010) and cognitive impairment (16.3% vs 8.0%, P = 0.029) was associated with the incidence of postoperative complications.

Conclusion: Preoperative frailty and cognitive impairment were associated with POD. However, preoperative frailty or cognitive impairment by themselves were comparably poor predictors of POD. A comprehensive predictive model including age, BMI, ASA status, duration of surgery, morphine equivalent, surgical risk, frailty and cognitive impairment was more useful to predict POD.

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利用老年患者术前虚弱和认知障碍评估预测术后谵妄。

目的虚弱和认知障碍与术后谵妄密切相关。本研究旨在比较评估术前虚弱和认知障碍的筛查工具预测术后谵妄（POD）的能力以及与术后并发症发生率、重症监护室（ICU）入院率和住院时间的关系：将 29 名年龄≥60 岁、接受择期胸腔或腹腔大手术的患者分为术前虚弱组和无虚弱组，或认知障碍组和无认知障碍组。主要结果是术后谵妄的发生率。次要结果包括术后并发症、入住重症监护室和住院时间：虚弱组（25.6% VS 14.6%，P = 0.017）和认知障碍组（32.7% VS 13.4%，P < 0.001）与 POD 相关。然而，虚弱（0.657 [95% CI 0.60-0.71]）和认知障碍（0.661 [95% CI 0.60-0.71]）与 POD 之间的接收器操作特征曲线下面积（AUC-ROC）并无差异（P = 0.9），均低于年龄、体重指数（BMI）、美国麻醉医师协会（ASA）状态、手术时间、吗啡当量、手术风险、虚弱和认知障碍的综合预测模型（0.814 [95% CI 0.77-0.86]，P < 0.0001，P < 0.0001）。此外，虚弱（15.6% vs 6.3%，P = 0.010）和认知障碍（16.3% vs 8.0%，P = 0.029）与术后并发症的发生率有关：结论：术前体弱和认知障碍与 POD 相关。结论：术前体弱和认知障碍与 POD 有关，但术前体弱或认知障碍本身对 POD 的预测效果较差。包括年龄、体重指数、ASA 状态、手术时间、吗啡当量、手术风险、虚弱和认知障碍在内的综合预测模型更有助于预测 POD。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.80

自引率

2.80%

发文量

193

审稿时长

6-12 weeks

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.