From the Centre for Clinical Research in Anesthesia, Department of Anesthesiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Surgical Centre, Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.
Anesth Analg. 2021 Mar 1;132(3):846-855. doi: 10.1213/ANE.0000000000005159.
Postoperative delirium is common among older patients and preoperative identification of high-risk patients is widely recommended. The aim of this study was to assess whether preoperative cognitive performance using brief screening tools or regional cerebral oxygen saturation (Scto2) was associated with the development of postoperative delirium in older Portuguese patients undergoing elective surgery.
Prospective observational cohort study where preoperative cognitive screening tools (Mini-Cog, Mini-Mental State Examination, verbal fluency) and Scto2 (INVOS 5100C; Medtronic, Ireland) were assessed in 238 patients ≥65 years old undergoing elective surgery between July 2017 and May 2019 at a tertiary academic center in Portugal. The primary outcome was postoperative delirium detected by the 3D-Confusion Assessment Method. Data were analyzed by univariate analysis and multivariable logistic regression.
Delirium was identified in 53 patients (22%); 162 patients (68%) had completed only 4 years of education. On multivariable analysis, probable cognitive impairment tested by the Mini-Cog (odds ratio [OR] = 1.57; 95% confidence interval [CI], 0.70-3.53; corrected P value >.999), by the Mini-Mental State Examination (OR = 2.75; 95% CI, 1.23-6.13; corrected P value = .052), and by the animal verbal fluency test (OR = 1.24; 95% CI, 0.49-3.16; corrected P value >.999) were not significantly associated with the development of postoperative delirium. In contrast, lower preoperative Scto2 (OR = 1.08; 95% CI, 1.02-1.14; corrected P value = .024 for each point decrease in Scto2) was associated with postoperative delirium.
We did not find enough evidence to suggest that poor preoperative cognitive performance was significantly associated with the development of postoperative delirium in an older Portuguese surgical population with an overall low level of formal education, but rather that preoperative Scto2 may be helpful in identifying patients at risk for delirium.
术后谵妄在老年患者中很常见，广泛建议术前识别高危患者。本研究旨在评估使用简短的筛查工具或区域性脑氧饱和度（Scto2）评估术前认知表现是否与葡萄牙行择期手术的老年患者术后谵妄的发生有关。
前瞻性观察队列研究，2017 年 7 月至 2019 年 5 月在葡萄牙一家三级学术中心，对 238 名≥65 岁的行择期手术的患者评估术前认知筛查工具（Mini-Cog、简易精神状态检查、言语流畅性）和 Scto2（INVOS 5100C；美敦力，爱尔兰）。主要结局是使用 3D 意识混乱评估方法检测到的术后谵妄。通过单变量分析和多变量逻辑回归进行数据分析。
53 例（22%）患者出现谵妄；162 例（68%）患者仅完成了 4 年的教育。多变量分析显示，Mini-Cog 检测到的可能认知障碍（比值比 [OR] = 1.57；95%置信区间 [CI]，0.70-3.53；校正后 P 值>.999）、简易精神状态检查（OR = 2.75；95% CI，1.23-6.13；校正后 P 值 =.052）和动物言语流畅性测试（OR = 1.24；95% CI，0.49-3.16；校正后 P 值>.999）与术后谵妄的发生无显著相关性。相反，较低的术前 Scto2（OR = 1.08；95% CI，1.02-1.14；校正后 Scto2 每降低 1 点，P 值 =.024）与术后谵妄有关。
我们没有发现足够的证据表明，在总体受教育程度较低的葡萄牙老年手术人群中，较差的术前认知表现与术后谵妄的发生有显著相关性，而术前 Scto2 可能有助于识别发生谵妄的高危患者。
