Mazzola Paolo, Ward Libby, Zazzetta Sara, Broggini Valentina, Anzuini Alessandra, Valcarcel Breanna, Brathwaite Justin S, Pasinetti Giulio M, Bellelli Giuseppe, Annoni Giorgio
School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, Monza, Italy.
J Am Geriatr Soc. 2017 Jun;65(6):1222-1228. doi: 10.1111/jgs.14764. Epub 2017 Mar 6.
To determine whether poor nutritional status can predict postoperative delirium in elderly adults undergoing hip fracture surgery.
Prospective observational cohort study.
Italian orthogeriatric unit.
Individuals aged 70 and older (mean age 84.0 ± 6.6, 74.5% female) consecutively admitted for surgical repair of a proximal femur fracture between September 2012 and April 2016 (N = 415).
Participants underwent a comprehensive geriatric assessment including nutritional status, which was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF). The MNA-SF-based three-class stratification was tested using multivariable logistic regression to assess its role in predicting postoperative delirium (outcome).
Seventy-eight malnourished individuals (MNA-SF score 0-7), 185 at risk of malnutrition (MNA-SF score 8-11), and 152 who were well nourished (MNA-SF score 12-14) were compared. On average, individuals with poor nutritional status were more disabled and more cognitively impaired than those who were well nourished and those at risk of malnutrition. Moreover, those who were malnourished were more likely to have postoperative delirium. Multivariate regression analysis adjusted for age, sex, comorbidity, functional impairment, preoperative cognitive status, and American Society of Anesthesiologists score showed that those who were at risk of malnutrition (odds ratio (OR) = 2.42, 95% confidence interval (CI) = 1.29-4.53) and those who were overtly malnourished (OR = 2.98, 95% CI = 1.43-6.19) were more likely to develop postoperative delirium.
This is the first study in a Western population showing that risk of malnutrition and overt malnutrition, as assessed using the MNA-SF, are independent predictors of postoperative delirium. Accordingly, nutritional status should be assessed in individuals with hip fracture before surgery to determine risk of developing delirium.
确定营养状况不佳是否能预测接受髋部骨折手术的老年人术后谵妄。
前瞻性观察性队列研究。
意大利老年骨科病房。
2012年9月至2016年4月期间连续入院接受股骨近端骨折手术修复的70岁及以上个体（平均年龄84.0±6.6岁，女性占74.5%）（N = 415）。
参与者接受了包括营养状况在内的全面老年医学评估，营养状况采用微型营养评定简表（MNA-SF）进行评估。基于MNA-SF的三级分层通过多变量逻辑回归进行检验，以评估其在预测术后谵妄（结局）中的作用。
比较了78名营养不良个体（MNA-SF评分0 - 7）、185名有营养不良风险个体（MNA-SF评分8 - 11）和152名营养良好个体（MNA-SF评分12 - 14）。平均而言，营养状况不佳的个体比营养良好和有营养不良风险的个体功能障碍更严重，认知障碍更明显。此外，营养不良的个体术后更易发生谵妄。经年龄、性别、合并症、功能障碍、术前认知状态和美国麻醉医师协会评分校正的多变量回归分析显示，有营养不良风险的个体（优势比（OR）= 2.42，95%置信区间（CI）= 1.29 - 4.53）和明显营养不良的个体（OR = 2.98，95% CI = 1.43 - 6.19）术后更易发生谵妄。
这是西方人群中的第一项研究，表明使用MNA-SF评估的营养不良风险和明显营养不良是术后谵妄的独立预测因素。因此，术前应对髋部骨折患者进行营养状况评估，以确定发生谵妄的风险。
