From the Department of Psychiatry, Shanghai Tenth People's Hospital, Anesthesia and Brain Research Institute (Z.S., X.M., Y.C., Hailin Zheng, Y.W., Y.S.) Department of Anesthesiology (C.L.), Tongji University School of Medicine, Shanghai, China the Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine (Z.S., Z.X.) the Biostatistics Center (Hui Zheng), Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts the Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai Pancreatic Cancer Institute, Fudan University, Shanghai 200032, China (L.L.) the Divisions of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (E.R.M.).
Anesthesiology. 2019 Sep;131(3):492-500. doi: 10.1097/ALN.0000000000002849.
Postoperative delirium is one of the most common complications in the elderly surgical population. However, its long-term outcomes remain largely to be determined. Therefore a prospective cohort study was conducted to determine the association between postoperative delirium and long-term decline in activities of daily living and postoperative mortality. The hypothesis in the present study was that postoperative delirium was associated with a greater decline in activities of daily living and higher mortality within 24 to 36 months after anesthesia and surgery.
The participants (at least 65 yr old) having the surgeries of (1) proximal femoral nail, (2) hip replacement, or (3) open reduction and internal fixation under general anesthesia were enrolled. The Confusion Assessment Method algorithm was administered to diagnose delirium before and on the first, second, and fourth days after the surgery. Activities of daily living were evaluated by using the Chinese version of the activities of daily living scale (range, 14 to 56 points), and preoperative cognitive function was assessed by using the Chinese Mini-Mental State Examination (range, 0 to 30 points). The follow-up assessments, including activities of daily living and mortality, were conducted between 24 and 36 months after anesthesia and surgery.
Of 130 participants (80 ± 6 yr, 24% male), 34 (26%) developed postoperative delirium during the hospitalization. There were 32% of the participants who were lost to follow-up, resulting in 88 participants who were finally included in the data analysis. The participants with postoperative delirium had a greater decline in activities of daily living (16 ± 15 vs. 9 ± 15, P = 0.037) and higher 36-month mortality (8 of 28, 29% vs. 7 of 75, 9%; P = 0.009) as compared with the participants without postoperative delirium.
Postoperative delirium was associated with long-term detrimental outcomes, including greater decline in activities of daily living and a higher rate of postoperative mortality.
术后谵妄是老年手术人群中最常见的并发症之一。然而，其长期后果在很大程度上仍有待确定。因此，进行了一项前瞻性队列研究，以确定术后谵妄与术后 24 至 36 个月内日常生活活动能力下降和术后死亡率之间的关系。本研究的假设是，术后谵妄与术后 24 至 36 个月内日常生活活动能力下降幅度更大和死亡率更高有关。
本研究纳入了接受全身麻醉下股骨近端髓内钉、髋关节置换或切开复位内固定手术的患者（年龄至少 65 岁）。在手术前和手术后第 1、2、4 天采用谵妄评估方法诊断谵妄。采用日常生活活动量表（范围 14 至 56 分）评估日常生活活动能力，采用中文版简易精神状态检查表（范围 0 至 30 分）评估术前认知功能。在麻醉和手术后 24 至 36 个月进行随访评估，包括日常生活活动能力和死亡率。
在 130 名参与者中（80 ± 6 岁，24%为男性），34 名（26%）在住院期间发生术后谵妄。有 32%的参与者失访，最终有 88 名参与者纳入数据分析。与无术后谵妄的参与者相比，发生术后谵妄的参与者日常生活活动能力下降幅度更大（16 ± 15 分比 9 ± 15 分，P = 0.037），36 个月死亡率更高（8 例/28 例，29%比 7 例/75 例，9%；P = 0.009）。
术后谵妄与长期不良结局相关，包括日常生活活动能力下降幅度更大和术后死亡率更高。
