术前简要筛查衰弱和认知障碍可预测脊柱手术后谵妄。
Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery.
出版信息
Anesthesiology. 2020 Dec 1;133(6):1184-1191. doi: 10.1097/ALN.0000000000003523.
BACKGROUND
Frailty and cognitive impairment are associated with postoperative delirium, but are rarely assessed preoperatively. The study was designed to test the hypothesis that preoperative screening for frailty or cognitive impairment identifies patients at risk for postoperative delirium (primary outcome).
METHODS
In this prospective cohort study, the authors administered frailty and cognitive screening instruments to 229 patients greater than or equal to 70 yr old presenting for elective spine surgery. Screening for frailty (five-item FRAIL scale [measuring fatigue, resistance, ambulation, illness, and weight loss]) and cognition (Mini-Cog, Animal Verbal Fluency) were performed at the time of the preoperative evaluation. Demographic data, perioperative variables, and postoperative outcomes were gathered. Delirium was the primary outcome detected by either the Confusion Assessment Method, assessed daily from postoperative day 1 to 3 or until discharge, if patient was discharged sooner, or comprehensive chart review. Secondary outcomes were all other-cause complications, discharge not to home, and hospital length of stay.
RESULTS
The cohort was 75 [73 to 79 yr] years of age, 124 of 219 (57%) were male. Many scored positive for prefrailty (117 of 218; 54%), frailty (53 of 218; 24%), and cognitive impairment (50 to 82 of 219; 23 to 37%). Fifty-five patients (25%) developed delirium postoperatively. On multivariable analysis, frailty (scores 3 to 5 [odds ratio, 6.6; 95% CI, 1.96 to 21.9; P = 0.002]) versus robust (score 0) on the FRAIL scale, lower animal fluency scores (odds ratio, 1.08; 95% CI, 1.01 to 1.51; P = 0.036) for each point decrease in the number of animals named, and more invasive surgical procedures (odds ratio, 2.69; 95% CI, 1.31 to 5.50; P = 0.007) versus less invasive procedures were associated with postoperative delirium.
CONCLUSIONS
Screening for frailty and cognitive impairment preoperatively using the FRAIL scale and the Animal Verbal Fluency test in older elective spine surgery patients identifies those at high risk for the development of postoperative delirium.
背景
虚弱和认知障碍与术后谵妄有关，但很少在术前进行评估。本研究旨在测试以下假设：术前筛查虚弱或认知障碍是否可以识别术后谵妄的高危患者（主要结局）。
方法
在这项前瞻性队列研究中，作者对 229 名年龄大于或等于 70 岁的择期脊柱手术患者进行了虚弱和认知筛查。在术前评估时进行了虚弱（五项 FRAIL 量表[测量疲劳、抵抗力、活动能力、疾病和体重减轻]）和认知（迷你认知测试、动物言语流畅性）筛查。收集了人口统计学数据、围手术期变量和术后结果。谵妄是通过混乱评估方法检测到的主要结局，从术后第 1 天到第 3 天每天评估，或者如果患者更早出院，则直到出院，或者通过全面的图表审查。次要结局是其他原因的并发症、非出院地出院和住院时间。
结果
该队列的年龄为 75 岁[73 至 79 岁]，219 名患者中有 124 名为男性。许多患者表现出虚弱前期（117/218；54%）、虚弱（53/218；24%）和认知障碍（219 名患者中有 50 至 82 名；23 至 37%）。55 名患者（25%）术后出现谵妄。多变量分析显示，与 FRAIL 量表上的健壮（评分 0）相比，虚弱（评分 3 至 5[比值比，6.6；95%置信区间，1.96 至 21.9；P = 0.002]）、动物流畅性评分每降低 1 分（比值比，1.08；95%置信区间，1.01 至 1.51；P = 0.036）和更具侵入性的手术程序（比值比，2.69；95%置信区间，1.31 至 5.50；P = 0.007）与术后谵妄相关。
结论
在老年择期脊柱手术患者中，使用 FRAIL 量表和动物言语流畅性测试术前筛查虚弱和认知障碍可识别出发生术后谵妄的高危患者。
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