Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ.
J Am Coll Surg. 2020 May;230(5):758-765. doi: 10.1016/j.jamcollsurg.2020.01.029. Epub 2020 Feb 21.
The prevalence of delirium and its impact on outcomes after emergency general surgery (EGS) remain unexplored. The aims of our study were to assess the impact of frailty on delirium and the impact of delirium on outcomes in geriatric EGS patients.
We performed a 1-year (2017) prospective cohort analysis of all geriatric (age ≥ 65 years) patients who underwent EGS. Frailty was calculated using the Emergency General Surgery-Specific Frailty Index (ESFI). Delirium was assessed using the Confusion Assessment Method (CAM). Patients were dichotomized as delirious or non-delirious. We performed regression analysis controlling for demographics, admission vitals, American Society of Anesthesiologists (ASA) score, comorbidity, and the diagnosis and type of surgery.
A total of 163 patients underwent emergency general surgery and were included. Mean age was 71 ± 7 years, and 59% were male. Overall, the incidence of postoperative delirium was 26%. Patients who developed postoperative delirium were more likely to be frail (40% vs 14%, p < 0.01), on more than 3 medications (29% vs 18%, p < 0.01), and were more likely to have 3 or more comorbidities (32% vs 21%, p < 0.01). On regression analysis, frail status (odds ratio [OR] 3.7 [2.4-4.2], p < 0.01) and receiving more than 3 medications (OR 1.3 [range 1.1-1.4], p < 0.01) were independent predictors of developing postoperative delirium. An episode of delirium was associated with longer hospital length of stay (LOS) (6 days vs 3 days, p < 0.01), higher odds of ICU admission (OR 2 [1.3-4.5], p < 0.01), longer ICU LOS (2 days vs 1 day, p < 0.01), and higher odds of unplanned intubation (OR 1.8 [1.2-3.4], p < 0.01).
The incidence of delirium after EGS was 26%. Frailty and polypharmacy were associated with increased risk of delirium. Delirium appears to be associated with higher rates of in-hospital adverse events.
在急诊普通外科（EGS）后，谵妄的发生率及其对结局的影响仍未得到探索。我们研究的目的是评估衰弱对谵妄的影响，以及谵妄对老年 EGS 患者结局的影响。
我们对所有接受 EGS 的老年（年龄≥65 岁）患者进行了为期 1 年（2017 年）的前瞻性队列分析。使用急诊普通外科特定衰弱指数（ESFI）计算衰弱程度。使用意识混乱评估方法（CAM）评估谵妄。患者分为谵妄或非谵妄。我们进行了回归分析，控制了人口统计学、入院生命体征、美国麻醉医师协会（ASA）评分、合并症以及手术的诊断和类型。
共有 163 名患者接受了急诊普通外科手术，纳入研究。平均年龄为 71±7 岁，59%为男性。总体而言，术后谵妄的发生率为 26%。发生术后谵妄的患者更有可能衰弱（40%比 14%，p<0.01），服用超过 3 种药物（29%比 18%，p<0.01），且合并症超过 3 种的可能性更高（32%比 21%，p<0.01）。回归分析显示，衰弱状态（比值比[OR]3.7[2.4-4.2]，p<0.01）和服用超过 3 种药物（OR 1.3[范围 1.1-1.4]，p<0.01）是发生术后谵妄的独立预测因素。谵妄发作与住院时间延长（6 天比 3 天，p<0.01）、入住 ICU 的几率增加（OR 2[1.3-4.5]，p<0.01）、ICU 住院时间延长（2 天比 1 天，p<0.01）和计划外插管的几率增加（OR 1.8[1.2-3.4]，p<0.01）有关。
EGS 后谵妄的发生率为 26%。衰弱和多种药物治疗与谵妄风险增加相关。谵妄似乎与更高的院内不良事件发生率有关。
