Sato Tendo, Hatakeyama Shingo, Okamoto Teppei, Yamamoto Hayato, Hosogoe Shogo, Tobisawa Yuki, Yoneyama Tohru, Hashiba Eiji, Yoneyama Takahiro, Hashimoto Yasuhiro, Koie Takuya, Hirota Kazuyoshi, Ohyama Chikara
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
PLoS One. 2016 May 4;11(5):e0153961. doi: 10.1371/journal.pone.0153961. eCollection 2016.
The aim of this study was to identify risk factors associated with postoperative delirium in patients undergoing urological surgery.
We prospectively evaluated pre- and postoperative risk factors for postoperative delirium in consecutive 215 patients who received urological surgery between August 2013 and November 2014. Preoperative factors included patient demographics, comorbidities, and frailty assessment. Frailty was measured by handgrip strength, fatigue scale of depression, fall risk assessment, and gait speed (the timed Get-up and Go test). Postoperative factors included types of anesthesia, surgical procedure, renal function and serum albumin decline, blood loss, surgery time, highest body temperature, and complications. Uni- and multivariate logistic regression analyses were performed to assess pre- and postoperative predictors for the development of postoperative delirium.
Median age of this cohort was 67 years. Ten patients (4.7%) experienced postoperative delirium. These patients were significantly older, had weak handgrip strength, a higher fall risk assessment score, slow gait speed, and greater renal function decline compared with patients without delirium. Multivariate analysis revealed slow gait speed (>13.0 s) and rapid renal function decline (>30%) were independent risk factors for postoperative delirium.
Slow gait speed and rapid renal function decline after urological surgery are significant factors for postoperative delirium. These data will be helpful for perioperative patient management. This study was registered as a clinical trial: UMIN: R000018809.
本研究旨在确定泌尿外科手术患者术后谵妄的相关危险因素。
我们前瞻性评估了2013年8月至2014年11月期间连续接受泌尿外科手术的215例患者术后谵妄的术前和术后危险因素。术前因素包括患者人口统计学特征、合并症和衰弱评估。通过握力、抑郁疲劳量表、跌倒风险评估和步态速度（定时起立行走测试）来测量衰弱程度。术后因素包括麻醉类型、手术方式、肾功能和血清白蛋白下降、失血、手术时间、最高体温及并发症。进行单因素和多因素逻辑回归分析，以评估术后谵妄发生的术前和术后预测因素。
该队列患者的中位年龄为67岁。10例患者（4.7%）发生术后谵妄。与未发生谵妄的患者相比，这些患者年龄显著更大，握力弱，跌倒风险评估得分更高，步态速度慢，且肾功能下降更明显。多因素分析显示，步态速度慢（>13.0秒）和肾功能快速下降（>30%）是术后谵妄的独立危险因素。
泌尿外科手术后步态速度慢和肾功能快速下降是术后谵妄的重要因素。这些数据将有助于围手术期患者管理。本研究已注册为一项临床试验：UMIN：R000018809。
