Department of Health Sciences, University of Milano-Bicocca, Milan, Italy; Geriatric Unit, S. Gerardo Hospital, Monza, Italy; Geriatric Research Group, Brescia, Italy.
J Am Geriatr Soc. 2014 Jul;62(7):1335-40. doi: 10.1111/jgs.12885. Epub 2014 Jun 2.
To evaluate the association between number of days with delirium and 6-month mortality in elderly adults after hip fracture surgery.
Prospective cohort study with 6-month follow-up.
Orthogeriatric Unit (OGU).
Individuals (mean age = 84.3 ± 6.4) admitted to the OGU between October 2011 and April 2013 with hip fracture (N = 199).
Postoperative delirium (POD) was assessed daily using the Confusion Assessment Method algorithm and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria. Multivariable Cox regression models were used to evaluate the association between POD of and 6-month mortality after surgery, after adjustment for covariates including age, prefracture residence, Katz activity of daily living score, New Mobility score, diagnosis of prefracture dementia, American Society of Anesthesiologists score, albumin serum levels, Charlson Comorbidity Index, and length of OGU stay.
Fifty-seven participants (28.6%) developed POD. In the 6-month period after surgery, 35 (17.6%) participants died: 16 of 57 (28.1%) with POD and 19/ of 142 (13.4%) with no POD. The average duration of POD was 2.0 ± 3.2 days for participants who died and 0.7 ± 1.8 days for those who survived (P < .001). After adjusting for covariates, each day of POD in the OGU increased the hazard of dying at 6 months by 17% (hazard ratio = 1.17, 95% confidence interval = 1.07-1.28).
In older adults undergoing hip fracture surgery, duration of POD is an important prognostic factor for 6-month mortality. Efforts to reduce duration of POD are therefore crucial for these individuals.
评估髋部骨折手术后老年患者谵妄天数与 6 个月死亡率之间的关系。
前瞻性队列研究，随访 6 个月。
骨科老年病房（OGU）。
2011 年 10 月至 2013 年 4 月期间因髋部骨折入住 OGU 的个体（平均年龄=84.3±6.4 岁），共 199 人。
术后谵妄（POD）采用谵妄评估方法算法和精神障碍诊断与统计手册，第四版，文本修订版标准，每天进行评估。多变量 Cox 回归模型用于评估手术后 POD 与 6 个月死亡率之间的关系，调整了包括年龄、骨折前居住地、Katz 日常生活活动评分、新移动评分、骨折前痴呆诊断、美国麻醉师协会评分、血清白蛋白水平、Charlson 合并症指数和 OGU 住院时间在内的协变量。
57 名参与者（28.6%）发生 POD。在手术后的 6 个月期间，35 名（17.6%）参与者死亡：57 名有 POD 的参与者中有 16 名（28.1%），142 名无 POD 的参与者中有 19 名（13.4%）。死亡参与者的 POD 平均持续时间为 2.0±3.2 天，存活参与者的 POD 持续时间为 0.7±1.8 天（P<.001）。在调整协变量后，OGU 中 POD 每增加一天，6 个月死亡的风险增加 17%（风险比=1.17，95%置信区间=1.07-1.28）。
在接受髋部骨折手术的老年患者中，POD 持续时间是 6 个月死亡率的一个重要预后因素。因此，减少 POD 持续时间对于这些患者至关重要。
