Gao Rui, Yang Zhi-Zhou, Li Ming, Shi Zhi-Cai, Fu Qiang
Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China.
Eur Spine J. 2008 Nov;17(11):1531-7. doi: 10.1007/s00586-008-0771-1. Epub 2008 Sep 16.
Postoperative delirium and its risk factors had been widely reported in several kinds of surgeries; however, there is only one known article relative to postoperative delirium in spinal surgery. We retrospectively examined the incidence of postoperative delirium and the probable risk factors in patients undergoing spinal surgery in our hospital, with the same aged non-delirium patients as controls, over a 6-month period. Studies about postoperative delirium were reviewed and referenced for variable factors collecting in our study. T tests, chi(2) test and logistic regression analysis were performed to evaluate the various factors related to postoperative delirium. A total of 18 patients (3.3%), all of them were aged 54 years or older, had postoperative delirium after surgery. Patients without postoperative delirium aged 54 years or older served as the control group. The percentage of patients older than 65 years (P = 0.003), with comorbid diseases such as diabetes mellitus (P = 0.042) or central nervous system disorders (P = 0.013), with a surgical history (P = 0.028) in delirium group was larger than the control group. The absolute number of medications being taken before the operation in the delirium patients was also more than the control group (P = 0.000). The percentage of patients transfused with 800 mL or more blood was also larger (P = 0.024) in delirium group was larger than the control group. Logistic regression analysis showed that central nervous system disorder (OR 6.480), surgical history (OR 3.499), age older than 65 years (OR 3.390), diabetes mellitus (OR 2.981), transfused 800 mL or more blood (OR 2.537), and hemoglobin less than 100 g/L (OR 0.281) were significantly related to the occurrence postoperative delirium. Our findings suggest that postoperative delirium in spinal surgery can also occurred in younger patients and with an acceptable incidence in total. The risk for postoperative delirium is multifactorial. More prospective research is necessary in order to evaluate these and other risk factors in greater detail.
术后谵妄及其危险因素在多种手术中已有广泛报道；然而，关于脊柱手术术后谵妄的已知文章仅有一篇。我们回顾性研究了我院脊柱手术患者术后谵妄的发生率及可能的危险因素，以年龄匹配的非谵妄患者作为对照，研究为期6个月。回顾并参考了有关术后谵妄的研究，以收集本研究中的可变因素。进行t检验、卡方检验和逻辑回归分析，以评估与术后谵妄相关的各种因素。共有18例患者（3.3%）术后出现谵妄，所有患者年龄均在54岁及以上。年龄54岁及以上未发生术后谵妄的患者作为对照组。谵妄组中65岁以上患者的比例（P = 0.003）、患有糖尿病（P = 0.042）或中枢神经系统疾病（P = 0.013）等合并症的患者比例、有手术史的患者比例（P = 0.028）均高于对照组。谵妄患者术前服用药物的绝对数量也多于对照组（P = 0.000）。谵妄组中输注800 mL及以上血液的患者比例也更高（P = 0.024）。逻辑回归分析显示，中枢神经系统疾病（OR 6.480）、手术史（OR 3.499）、年龄大于65岁（OR 3.390）、糖尿病（OR 2.981）、输注800 mL及以上血液（OR 2.537）以及血红蛋白低于100 g/L（OR 0.281）与术后谵妄的发生显著相关。我们的研究结果表明，脊柱手术术后谵妄也可发生在较年轻患者中，总体发生率可接受。术后谵妄的风险是多因素的。需要更多的前瞻性研究来更详细地评估这些及其他危险因素。
