Department of Neurological Surgery, University of California, San Francisco, California, USA.
Department of Neurological Surgery, University of California, San Francisco, California, USA.
World Neurosurg. 2019 Jun;126:e930-e936. doi: 10.1016/j.wneu.2019.03.012. Epub 2019 Mar 11.
There are limited reports examining delirium in cohorts of neurosurgical patients across inpatient settings without separation based on subspecialty distinction. It is of interest to identify consistent delirium risk factors across various cranial pathologies and inpatient settings that will inform future interventional studies.
Delirium rates, patient and hospitalization risk factors, and clinical outcomes in 235 patients undergoing a cranial procedure were examined in a retrospective fashion.
Fifty-two (22.1%) patients experienced delirium during their hospital stay. Patient factors predictive of delirium on univariate logistic regression were older age, a diagnosis of hydrocephalus or intracranial infection, transfer from an outside hospital, and admission through the emergency department. Hospitalization factors predictive of delirium included longer length of intensive care unit (ICU) stay, abnormal sodium values preceding delirium, a new postoperative infection, and the presence of a neurologic deficit. Using recursive partitioning, age ≥72.56 years and ICU length of stay ≥5 days were identified as critical thresholds for predicting delirium (odds ratio [OR] 4.61 and 18.2, respectively). On multivariate logistic regression analysis, age (unit OR 1.05), length of ICU stay (unit OR 1.2), and a neurologic deficit (OR 5.4) were predictive of delirium. Furthermore, delirium was also significantly associated with a longer length of admission as well as decreased likelihood for discharge home.
Delirium is a frequent occurrence after neurosurgery with older age, longer ICU stay, and a neurologic deficit being consistent risk factors across inpatient settings. These results help identify at-risk patients for delirium on a neurosurgical service to enact interventions preemptively.
在没有根据亚专科区别进行区分的情况下，对住院患者人群中的谵妄进行检查的神经外科患者队列中，相关报告的数量有限。确定各种颅病理和住院环境中一致的谵妄危险因素，为未来的干预性研究提供信息，这一点很有意义。
回顾性地检查了 235 例接受颅脑手术的患者的谵妄发生率、患者和住院相关危险因素以及临床结局。
52 例（22.1%）患者在住院期间发生了谵妄。单变量逻辑回归分析显示，患者发生谵妄的预测因素为年龄较大、脑积水或颅内感染、从外院转来以及从急诊科入院。预测谵妄的住院相关因素包括重症监护病房（ICU）住院时间较长、谵妄前出现异常钠值、新的术后感染以及存在神经功能缺损。使用递归分区，年龄≥72.56 岁和 ICU 住院时间≥5 天被确定为预测谵妄的关键阈值（比值比[OR]分别为 4.61 和 18.2）。在多变量逻辑回归分析中，年龄（单位 OR 1.05）、ICU 住院时间（单位 OR 1.2）和神经功能缺损（OR 5.4）是谵妄的预测因素。此外，谵妄与住院时间延长以及出院回家的可能性降低显著相关。
神经外科手术后谵妄的发生率较高，年龄较大、ICU 住院时间较长和神经功能缺损是住院环境中一致的危险因素。这些结果有助于在神经外科病房识别出发生谵妄的高危患者，以便提前采取干预措施。
