Neufeld Karin J, Leoutsakos Jeannie-Marie S, Oh Esther, Sieber Frederick E, Chandra Anita, Ghosh Ankita, Schretlen David J, Needham Dale M
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Am J Geriatr Psychiatry. 2015 Oct;23(10):1067-74. doi: 10.1016/j.jagp.2015.03.004. Epub 2015 Mar 27.
Postoperative delirium, occurring days after surgery, is associated with both short- and long-term adverse events. Postanesthesia care unit (PACU) delirium, immediately after recovery from anesthesia, is associated with continued delirium in the succeeding days and adverse cognitive outcomes at discharge. Longer-term consequences are unclear. The objective was to evaluate 18-month outcomes of patients with versus without delirium in the PACU after surgery with general anesthesia.
In a prospective, observational, cohort study, 91 consecutive English-speaking patients, aged at least 70 years and capable of independently providing informed consent before surgery, were followed after admission for a surgical procedure in one teaching hospital. Patients completed cognitive testing before surgery. After recovery from general anesthesia, they were evaluated for a DSM-IV diagnosis of delirium. Participants or proxies were evaluated, at a median of 19 months after surgery (interquartile range: 18-20 months), for survival, cognitive and physical functioning, and healthcare utilization outcomes.
All 91 patients or proxies (41 with delirium [45%]) were contacted at follow-up, with 7 deaths (8%) and 3 declining further participation (3%); 81 (96% of survivors) completed follow-up evaluations, demonstrating no significant cognitive or functional decline from baseline, with 75% of the cohort living independently in the community, and no differences in any outcomes between patients with versus without PACU delirium.
In a small cohort of older patients evaluated 18 months after surgery, we could not detect an association of delirium diagnosed in the PACU with patient survival, cognitive/physical functioning, and healthcare utilization.
术后谵妄发生在手术后数天，与短期和长期不良事件均相关。麻醉后护理单元（PACU）谵妄发生在麻醉恢复后即刻，与后续数天持续谵妄及出院时不良认知结局相关。长期后果尚不清楚。目的是评估全身麻醉手术后PACU中发生谵妄与未发生谵妄患者的18个月结局。
在一项前瞻性观察性队列研究中，对一家教学医院收治接受外科手术的91例连续的英语患者进行随访，这些患者年龄至少70岁，术前能够独立提供知情同意。患者在手术前完成认知测试。全身麻醉恢复后，对其进行谵妄的DSM-IV诊断评估。在手术后中位数19个月（四分位间距：18 - 20个月）时，对参与者或代理人进行生存、认知和身体功能以及医疗保健利用结局评估。
随访时联系了所有91例患者或代理人（41例发生谵妄[45%]），7例死亡（8%），3例拒绝进一步参与（3%）；81例（幸存者的96%）完成了随访评估，显示与基线相比无显著认知或功能下降，75%的队列患者在社区独立生活，PACU发生谵妄与未发生谵妄的患者在任何结局方面均无差异。
在一小群术后18个月接受评估的老年患者中，我们未发现PACU中诊断的谵妄与患者生存、认知/身体功能及医疗保健利用之间存在关联。
