Department of Neurosurgery, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania.
Lithuanian University of Health Sciences, Kaunas, Lithuania.
Acta Neurochir (Wien). 2018 Dec;160(12):2327-2337. doi: 10.1007/s00701-018-3718-2. Epub 2018 Nov 8.
Delirium is an acute and reversible deterioration of mental state. Postoperative delirium (POD) can develop after surgical procedures and is associated with impaired health status and worse recovery. So far, there is little data about postoperative delirium after brain surgery. The aim of this study was to evaluate frequency, risk factors, and prognostic value of POD in predicting short-term postoperative outcomes after brain tumor surgery.
Five-hundred and twenty-two patients who underwent elective brain tumor surgery in 2010-2017 were included in this prospective study. Patients were monitored for POD using the Confusion Assessment Method for the ICU (CAM-ICU) for 2 to 7 days after the surgery. At hospital discharge, outcomes were evaluated using the Glasgow Outcome Scale (GOS).
POD was diagnosed in 22 (4.2%) patients. Risk factors of POD were low level of hemoglobin, poor functional status at time of admission, low education level and older age (65 years and older). POD incidence was not associated with brain tumor laterality, location, extent of resection, histological diagnosis, or affected brain lobe. POD was associated with greater risk for unfavorable outcomes at hospital discharge (OR = 5.3; 95% CI [2.1-13.4], p = 0.001).
POD is not a common complication after elective brain tumor surgery. Older age, poor functional status, low education level and anemia are associated with greater POD risk. Extent of surgical intervention and brain tumor location are not associated with POD risk. POD is associated with worse outcome at hospital discharge.
谵妄是一种急性且可逆转的精神状态恶化。手术后谵妄（POD）可在手术后发生，并与健康状况受损和恢复不良有关。迄今为止，有关脑手术后 POD 的数据很少。本研究旨在评估脑肿瘤手术后 POD 的频率、危险因素及其预测短期术后结局的预后价值。
本前瞻性研究纳入了 2010 年至 2017 年间接受择期脑肿瘤手术的 522 例患者。术后 2 至 7 天使用 ICU 意识模糊评估法（CAM-ICU）对患者进行 POD 监测。在出院时，使用格拉斯哥预后量表（GOS）评估患者的预后。
22 例（4.2%）患者被诊断为 POD。POD 的危险因素包括血红蛋白水平低、入院时功能状态差、受教育程度低和年龄较大（65 岁及以上）。POD 的发生率与脑肿瘤的侧别、位置、切除范围、组织学诊断或受累脑叶无关。POD 与出院时预后不良的风险增加相关（OR=5.3；95%CI[2.1-13.4]，p=0.001）。
POD 不是择期脑肿瘤手术后的常见并发症。年龄较大、功能状态差、受教育程度低和贫血与 POD 风险增加有关。手术干预的范围和脑肿瘤的位置与 POD 风险无关。POD 与出院时的预后不良有关。
