Adogwa Owoicho, Elsamadicy Aladine A, Vuong Victoria D, Fialkoff Jared, Cheng Joseph, Karikari Isaac O, Bagley Carlos A
1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.
J Neurosurg Spine. 2018 Jan;28(1):103-108. doi: 10.3171/2017.5.SPINE161244. Epub 2017 Nov 10.
OBJECTIVE Postoperative delirium is common in elderly patients undergoing spine surgery and is associated with a longer and more costly hospital course, functional decline, postoperative institutionalization, and higher likelihood of death within 6 months of discharge. Preoperative cognitive impairment may be a risk factor for the development of postoperative delirium. The aim of this study was to investigate the relationship between baseline cognitive impairment and postoperative delirium in geriatric patients undergoing surgery for degenerative scoliosis. METHODS Elderly patients 65 years and older undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative cognition was assessed using the validated Saint Louis University Mental Status (SLUMS) examination. SLUMS comprises 11 questions, with a maximum score of 30 points. Mild cognitive impairment was defined as a SLUMS score between 21 and 26 points, while severe cognitive impairment was defined as a SLUMS score of ≤ 20 points. Normal cognition was defined as a SLUMS score of ≥ 27 points. Delirium was assessed daily using the Confusion Assessment Method (CAM) and rated as absent or present on the basis of CAM. The incidence of delirium was compared in patients with and without baseline cognitive impairment. RESULTS Twenty-two patients (18%) developed delirium postoperatively. Baseline demographics, including age, sex, comorbidities, and perioperative variables, were similar in patients with and without delirium. The length of in-hospital stay (mean 5.33 days vs 5.48 days) and 30-day hospital readmission rates (12.28% vs 12%) were similar between patients with and without delirium, respectively. Patients with preoperative cognitive impairment (i.e., a lower SLUMS score) had a higher incidence of postoperative delirium. One- and 2-year patient reported outcomes scores were similar in patients with and without delirium. CONCLUSIONS Cognitive impairment is a risk factor for the development of postoperative delirium. Postoperative delirium may be associated with decreased preoperative cognitive reserve. Cognitive impairment assessments should be considered in the preoperative evaluations of elderly patients prior to surgery.
术后谵妄在接受脊柱手术的老年患者中很常见，且与更长、费用更高的住院病程、功能衰退、术后入住养老院以及出院后6个月内更高的死亡可能性相关。术前认知障碍可能是术后谵妄发生的一个危险因素。本研究的目的是调查老年退行性脊柱侧凸手术患者基线认知障碍与术后谵妄之间的关系。方法：本研究纳入65岁及以上计划接受择期脊柱手术以矫正成人退行性脊柱侧凸的老年患者。术前认知功能采用经过验证的圣路易斯大学精神状态（SLUMS）检查进行评估。SLUMS包括11个问题，满分30分。轻度认知障碍定义为SLUMS评分在21至26分之间，而重度认知障碍定义为SLUMS评分≤20分。正常认知定义为SLUMS评分≥27分。每日使用谵妄评估方法（CAM）评估谵妄情况，并根据CAM将其评定为存在或不存在。比较有和无基线认知障碍患者的谵妄发生率。结果：22例患者（18%）术后发生谵妄。有和无谵妄患者的基线人口统计学特征，包括年龄、性别、合并症和围手术期变量相似。有和无谵妄患者的住院时间（平均5.33天对5.48天）和30天再入院率（12.28%对12%）分别相似。术前有认知障碍（即较低的SLUMS评分）的患者术后谵妄发生率更高。有和无谵妄患者1年和2年的患者报告结局评分相似。结论：认知障碍是术后谵妄发生的危险因素。术后谵妄可能与术前认知储备降低有关。在老年患者术前评估中应考虑进行认知障碍评估。
