Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China.
Department of Anesthesiology, Taizhou Hospital, Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
BMC Anesthesiol. 2020 Aug 1;20(1):189. doi: 10.1186/s12871-020-01096-6.
Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. Nevertheless, cognitive impairment in a large proportion of geriatric patients has not been well identified and diagnosed.
This is a cross-sectional study. Mini-mental state examination scale was used to assess the cognitive function of elderly patients aged ≥65 years undergoing orthopedic surgery preoperatively. The baseline, living habits and laboratory examination results of two groups were compared, and a multivariable logistic regression model was used to identify independent predictors of preoperative cognitive impairment.
A total of 374 elderly patients with orthopedic surgery indications met the inclusion criteria, and 28.61% of them had preoperative cognitive impairment. Multivariable logistic regression analysis showed that age (OR = 1.089, P < 0.001), subjective sleep disorders (OR = 1.996, P = 0.021), atherosclerosis (OR = 2.367, P = 0.017), and high cholesterol level (OR = 1.373, P = 0.028) were independent risk factors for preoperative cognitive impairment, while high education level performed as a protective factor (compared with the illiterate group, primary school group: OR = 0.413, P = 0.009; middle school or above group: OR = 0.120, P < 0.001).
The prevalence of preoperative cognitive dysfunction in geriatric elective orthopedic surgical patients was high. Our study identified venerable age, low level of education, subjective sleep disorders, atherosclerosis, and high cholesterol level as risk factors for preoperative cognitive impairment in these patients. Understanding these risk factors contributes to assisting in prevention and directed interventions for the high-risk population.
术前认知障碍正成为老年人术后不良预后的预测因素。然而，很大一部分老年患者的认知障碍尚未得到充分识别和诊断。
这是一项横断面研究。术前使用简易精神状态检查量表评估年龄≥65 岁接受骨科手术的老年患者的认知功能。比较两组患者的基线资料、生活习惯和实验室检查结果，采用多变量 logistic 回归模型确定术前认知障碍的独立预测因素。
共纳入 374 例符合骨科手术指征的老年患者，其中 28.61%存在术前认知障碍。多变量 logistic 回归分析显示，年龄（OR=1.089，P<0.001）、主观睡眠障碍（OR=1.996，P=0.021）、动脉粥样硬化（OR=2.367，P=0.017）和高胆固醇水平（OR=1.373，P=0.028）是术前认知障碍的独立危险因素，而高教育水平则是保护性因素（与文盲组相比，小学组：OR=0.413，P=0.009；中学及以上组：OR=0.120，P<0.001）。
老年择期骨科手术患者术前认知功能障碍的发生率较高。本研究确定了高龄、低教育水平、主观睡眠障碍、动脉粥样硬化和高胆固醇水平是这些患者术前认知障碍的危险因素。了解这些危险因素有助于针对高危人群进行预防和有针对性的干预。
