Ashley Knebel,Manjot Singh,Rhea Rasquinha,Mohammad Daher,Joseph E Nassar,John Hanna,Bassel G Diebo,Alan H Daniels
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After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analyzed.\r\n\r\nRESULTS\r\nAmong 476,482 no POD and 2,591 POD patients, mean age was 60.90 years, 57.6% were female, and mean CCI was 1.78. POD patients frequently had baseline cognitive impairment (p<0.001). Incidence of POD decreased from 0.7% in 2010 to 0.4% in 2022 (p<0.001) and increased with increasing patient age (p<0.001). POD patients had higher length of stay (12 vs 6 days, p<0.001) and 90-day costs ($20,605 vs $17,849, p<0.001). After matching, POD patients had higher hypernatremia (5.8% vs 3.5%, p=0.001) and hypocalcemia (5.0% vs 3.5%, p=0.026). POD patients had higher 90-day postoperative complications (p<0.05) than no POD patients.\r\n\r\nCONCLUSION\r\nNearly 0.5% of patients who underwent posterior spinal fusion between 2010-2022 developed delirium, although incidence rates have decreased over time. POD was common in elderly patients with electrolyte disturbances who underwent multi-level fusions. Patients suffering from POD had higher rates of 90-day postoperative complications. Ongoing efforts to deliver interventions to mitigate the consequences of POD among spine surgery patients are warranted.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Postoperative Delirium Following Posterior Lumbar Spinal Fusion: Epidemiology, Risk Factors, and Associated Complications.\",\"authors\":\"Ashley Knebel,Manjot Singh,Rhea Rasquinha,Mohammad Daher,Joseph E Nassar,John Hanna,Bassel G Diebo,Alan H Daniels\",\"doi\":\"10.1016/j.wneu.2024.09.038\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND\\r\\nPostoperative delirium (POD) is frequently reported in the elderly after major surgery. Several risk factors have been identified, including age, surgical complexity, and comorbidities.\\r\\n\\r\\nMETHODS\\r\\nPosterior lumbar fusion patients were identified using PearlDiver and filtered into two cohorts based on presence or absence of POD within 7 days of surgery. Epidemiological analyses were performed to examine trends in POD by age and year. Comparative analyses were performed on patient demographics and baseline cognitive status. After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analyzed.\\r\\n\\r\\nRESULTS\\r\\nAmong 476,482 no POD and 2,591 POD patients, mean age was 60.90 years, 57.6% were female, and mean CCI was 1.78. POD patients frequently had baseline cognitive impairment (p<0.001). Incidence of POD decreased from 0.7% in 2010 to 0.4% in 2022 (p<0.001) and increased with increasing patient age (p<0.001). 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引用次数: 0
摘要
背景术后谵妄(POD)是老年人大手术后的常见症状。方法使用 PearlDiver 对腰椎后路融合术患者进行识别,并根据术后 7 天内是否出现 POD 筛选出两个队列。进行流行病学分析,研究不同年龄和年份的 POD 变化趋势。对患者的人口统计学特征和基线认知状态进行了比较分析。结果在 476,482 名无 POD 患者和 2,591 名有 POD 患者中,平均年龄为 60.90 岁,57.6% 为女性,平均 CCI 为 1.78。POD 患者常伴有基线认知障碍(p<0.001)。POD 发生率从 2010 年的 0.7% 降至 2022 年的 0.4%(p<0.001),并随着患者年龄的增加而增加(p<0.001)。POD患者的住院时间(12天 vs 6天,p<0.001)和90天费用(20,605美元 vs 17,849美元,p<0.001)均较高。匹配后,POD 患者的高钠血症(5.8% vs 3.5%,p=0.001)和低钙血症(5.0% vs 3.5%,p=0.026)发生率更高。结论 2010-2022 年间接受后路脊柱融合术的患者中约有 0.5% 出现谵妄,尽管随着时间的推移发病率有所下降。电解质紊乱的老年患者接受多层次脊柱融合术时常出现谵妄。POD患者术后90天并发症发生率较高。我们有必要继续努力提供干预措施,以减轻脊柱手术患者的 POD 后果。
Postoperative Delirium Following Posterior Lumbar Spinal Fusion: Epidemiology, Risk Factors, and Associated Complications.
BACKGROUND
Postoperative delirium (POD) is frequently reported in the elderly after major surgery. Several risk factors have been identified, including age, surgical complexity, and comorbidities.
METHODS
Posterior lumbar fusion patients were identified using PearlDiver and filtered into two cohorts based on presence or absence of POD within 7 days of surgery. Epidemiological analyses were performed to examine trends in POD by age and year. Comparative analyses were performed on patient demographics and baseline cognitive status. After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analyzed.
RESULTS
Among 476,482 no POD and 2,591 POD patients, mean age was 60.90 years, 57.6% were female, and mean CCI was 1.78. POD patients frequently had baseline cognitive impairment (p<0.001). Incidence of POD decreased from 0.7% in 2010 to 0.4% in 2022 (p<0.001) and increased with increasing patient age (p<0.001). POD patients had higher length of stay (12 vs 6 days, p<0.001) and 90-day costs ($20,605 vs $17,849, p<0.001). After matching, POD patients had higher hypernatremia (5.8% vs 3.5%, p=0.001) and hypocalcemia (5.0% vs 3.5%, p=0.026). POD patients had higher 90-day postoperative complications (p<0.05) than no POD patients.
CONCLUSION
Nearly 0.5% of patients who underwent posterior spinal fusion between 2010-2022 developed delirium, although incidence rates have decreased over time. POD was common in elderly patients with electrolyte disturbances who underwent multi-level fusions. Patients suffering from POD had higher rates of 90-day postoperative complications. Ongoing efforts to deliver interventions to mitigate the consequences of POD among spine surgery patients are warranted.
期刊介绍:
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS