From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo).
Can J Surg. 2019 Feb 1;62(1):33-38. doi: 10.1503/cjs.016817.
Among older inpatients, the highest incidence of delirium is within the surgical population. Limited data are available regarding postoperative delirium risk in the acute care surgical population. The purpose of our study was to establish the incidence of and risk factors for delirium in an older acute care surgery population.
Patients aged 65 years or more who had undergone acute care surgery between April 2014 and September 2015 at 2 university-affiliated hospitals in Alberta were followed prospectively and screened for delirium by means of a validated chart review method. Delirium duration was recorded. We used separate multivariable logistic regression models to identify independent predictors for overall delirium and longer episodes of delirium (duration ≥ 48 h).
Of the 322 patients included, 73 (22.7%) were identified as having experienced delirium, with 49 (15.2%) experiencing longer episodes of delirium. Postoperative delirium risk factors included Foley catheter use, intestinal surgery, gallbladder surgery, appendix surgery, intensive care unit (ICU) admission and mild to moderate frailty. Risk factors for prolonged postoperative delirium included Foley catheter use and mild to moderate frailty. Surgical approach (open v. laparoscopic) and overall operative time were not found to be significant.
In keeping with the literature, our study identified Foley catheter use, frailty and ICU admission as risk factors for delirium in older acute care surgical patients. We also identified an association between delirium risk and the specific surgical procedure performed. Understanding these risk factors can assist in prevention and directed interventions for this high-risk population.
在老年住院患者中，手术人群的谵妄发生率最高。关于急性外科重症监护人群术后谵妄风险的数据有限。我们研究的目的是确定老年急性外科重症监护人群中谵妄的发生率和危险因素。
2014 年 4 月至 2015 年 9 月，在阿尔伯塔省的 2 所大学附属医院接受急性外科手术的年龄在 65 岁及以上的患者被前瞻性随访，并通过验证的图表审查方法筛查谵妄。记录谵妄持续时间。我们使用单独的多变量逻辑回归模型来确定总体谵妄和更长时间的谵妄（持续时间≥48 小时）的独立预测因素。
在纳入的 322 名患者中，有 73 名（22.7%）被确定为经历了谵妄，其中 49 名（15.2%）经历了更长时间的谵妄。术后谵妄的危险因素包括 Foley 导管使用、肠道手术、胆囊手术、阑尾手术、重症监护病房（ICU）入院和轻度至中度虚弱。延长术后谵妄的危险因素包括 Foley 导管使用和轻度至中度虚弱。手术方法（开放手术与腹腔镜手术）和总手术时间未被发现是显著的。
与文献一致，我们的研究确定了 Foley 导管使用、虚弱和 ICU 入院是老年急性外科重症监护患者谵妄的危险因素。我们还发现谵妄风险与所进行的具体手术之间存在关联。了解这些危险因素可以帮助高危人群进行预防和有针对性的干预。
