Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
BMC Geriatr. 2020 Feb 3;20(1):40. doi: 10.1186/s12877-020-1449-8.
To identify the incidence of, risk factors for, and outcomes associated with postoperative delirium (POD) in older adult patients who underwent noncardiac surgery.
This prospective study recruited patients aged ≥ 60 years who were scheduled to undergo noncardiac surgery at Siriraj Hospital (Bangkok, Thailand). Functional and cognitive statuses were assessed preoperatively using Barthel Index (BI) and the modified Informant Questionnaire on Cognitive Decline in the Elderly, respectively. POD was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition criteria. Incidence of POD was reported. Univariate and multivariate analyses were used to identify risk factors for POD.
Of the 249 included patients, 29 (11.6%) developed POD. Most patients (61.3%) developed delirium on postoperative day 1. Univariate analysis showed age ≥ 75 years, BI score ≤ 70, pre-existing dementia, preoperative use of opioid or benzodiazepine, preoperative infection, and hematocrit < 30% to be significantly associated with POD. Multivariate logistic analysis revealed pre-existing dementia (adjusted risk ratio [RR]: 3.95, 95% confidence interval [CI]: 1.91-8.17; p < 0.001) and age ≥ 75 years (adjusted RR: 2.54, 95% CI: 1.11-5.80; p = 0.027) to be independent risk factors for POD. Median length of hospital stay was 10 (range: 3-36) days for patients with POD versus 6 (range: 2-76) days for those without delirium (p < 0.001).
POD remains a common surgical complication, with an incidence of 11.6%. Patients with pre-existing dementia and age ≥ 75 years are the most vulnerable high-risk group. A multidisciplinary team consisting of anesthesiologists and geriatricians should implement perioperative care to prevent and manage POD.
本研究旨在明确老年非心脏手术患者术后谵妄（POD）的发生率、风险因素和结局。
本前瞻性研究纳入了在泰国曼谷诗里叻医院拟行非心脏手术的年龄≥60 岁的患者。术前分别采用巴氏指数（BI）和改良长谷川痴呆量表评估患者的功能和认知状态。根据《精神障碍诊断与统计手册（第五版）》的标准诊断 POD。报告 POD 的发生率。采用单因素和多因素分析确定 POD 的风险因素。
249 例患者中，29 例（11.6%）发生了 POD。大多数患者（61.3%）于术后第 1 天发生谵妄。单因素分析显示，年龄≥75 岁、BI 评分≤70、术前痴呆、术前使用阿片类或苯二氮䓬类药物、术前感染和血细胞比容<30%与 POD 显著相关。多因素 logistic 分析显示，术前痴呆（校正风险比[RR]：3.95，95%置信区间[CI]：1.91-8.17；p<0.001）和年龄≥75 岁（RR：2.54，95%CI：1.11-5.80；p=0.027）是 POD 的独立危险因素。发生 POD 的患者中位住院时间为 10（范围：3-36）天，而未发生谵妄的患者为 6（范围：2-76）天（p<0.001）。
POD 仍然是一种常见的手术并发症，发生率为 11.6%。有术前痴呆和年龄≥75 岁的患者是最易发生 POD 的高危人群。应由麻醉科医生和老年科医生组成的多学科团队实施围手术期护理，以预防和管理 POD。
