Department of anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo City, Zhejiang Province, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo City, Zhejiang Province, China.
Department of anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo City, Zhejiang Province, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo City, Zhejiang Province, China.
J Arthroplasty. 2021 Feb;36(2):449-453. doi: 10.1016/j.arth.2020.07.074. Epub 2020 Aug 4.
Postoperative delirium (POD) and delayed neurocognitive recovery are 2 common subtypes of postoperative neurocognitive disorders that occur after total joint arthroplasty (TJA), associated with inferior surgical outcomes. The modified frailty index (mFI) reflects the status of physiologic decline and predicts adverse outcomes in various surgical patient cohorts. This study aims at examining the discriminatory value of the mFI to predict POD and delayed neurocognitive recovery after TJA.
The study includes 383 participants admitted for primary elective TJA under general anesthesia combined with inhalation agents over the period from January 2018 to December 2019. POD and delayed neurocognitive recovery, based on the criteria provided by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013), were assessed for each enrolled patient. A multivariate logistic regression analysis was performed to screen potential risk factors for POD and delayed neurocognitive recovery.
The total incidence of POD and the delayed neurocognitive recovery of this cohort were 17.2% (66/383) and 24.8% (95/383), respectively. Our data from the multivariate logistic regression analysis indicated that a higher age (≥72 years) and a higher mFI level (≥0.18) were 2 independent risk factors for both POD and delayed neurocognitive recovery in elderly subjects after TJA.
The mFI may be a promising predictor for both POD and delayed neurocognitive recovery in elderly subjects following TJA. Preoperative mFI evaluation can be used for risk stratification and offers significant potential in clinical application.
术后谵妄（POD）和延迟性神经认知恢复是全膝关节置换术后（TJA）两种常见的术后神经认知障碍亚型，与较差的手术结果相关。改良衰弱指数（mFI）反映了生理衰退的状态，并预测了各种手术患者队列的不良结局。本研究旨在探讨 mFI 对 TJA 后 POD 和延迟性神经认知恢复的预测价值。
该研究纳入了 2018 年 1 月至 2019 年 12 月期间接受全身麻醉联合吸入剂的初次择期 TJA 的 383 名患者。根据《精神障碍诊断与统计手册》第五版（2013 年）的标准，对每位入组患者进行 POD 和延迟性神经认知恢复的评估。采用多变量 logistic 回归分析筛选 POD 和延迟性神经认知恢复的潜在危险因素。
该队列的 POD 总发生率和延迟性神经认知恢复发生率分别为 17.2%（66/383）和 24.8%（95/383）。多变量 logistic 回归分析数据表明，高龄（≥72 岁）和 mFI 水平较高（≥0.18）是 TJA 后老年患者发生 POD 和延迟性神经认知恢复的 2 个独立危险因素。
mFI 可能是 TJA 后老年患者发生 POD 和延迟性神经认知恢复的有前途的预测指标。术前 mFI 评估可用于风险分层，具有重要的临床应用潜力。
