Harcourt Building, Sheffield, UK.
Aintree University Hospitals NHS Foundation Trust, Liverpool, UK.
Bone Joint J. 2020 Dec;102-B(12):1675-1681. doi: 10.1302/0301-620X.102B12.BJJ-2019-1537.R3.
Postoperative delirium (POD) and postoperative cognitive decline (POCD) are common surgical complications. In the UK, the Best Practice Tariff incentivizes the screening of delirium in patients with hip fracture. Further, a National Hip Fracture Database (NHFD) performance indicator is the reduction in the incidence of POD. To aid in its recognition, we sought to determine factors associated with POD and POCD in patients with hip fractures.
We interrogated the NHFD data on patients presenting with hip fractures to our institution from 2016 to 2018. POD was determined using the 4AT score, as recommended by the NHFD and UK Department of Health. POCD was defined as a decline in Abbreviated Mental Test Score (AMTS) of two or greater. Using logistic regression, we adjusted for covariates to identify factors associated with POD and POCD.
Of the 1,224 patients presenting in the study period, 1,023 had complete datasets for final analysis. POD was observed in 242 patients (25%). On multivariate analysis only preoperative AMTS and American Society of Anesthesiologists grade (ASA) were independent predictors of POD. Every point increase in AMTS was associated with a fall in the odds of POD by a factor of 0.60 (95% confidence interval (CI) 0.56 to 0.63, p < 0.001). Every grade increase in ASA led to a 1.7-fold increase in the odds of POD (95% CI 1.13 to 2.50, p = 0.009). A preoperative AMTS of less than 8 was strongly predictive of POD with area under the receiver operating characteristic of 0.86 (95% CI 0.84 to 0.89). Only ASA was predictive of POCD-every grade increase in ASA led to a 2.6-fold increase in the odds of POCD (95% CI 1.7 to 4.0, p < 0.001).
POD and POCD are common in the hip fracture patients. Preoperative AMTS and ASA are strong predictors of POD, and ASA predictive of POCD. This may aid in the earlier identification of those most at risk and suited for the patient consent and decision-making process. Cite this article: 2020;102-B(12):1675-1681.
术后谵妄（POD）和术后认知功能障碍（POCD）是常见的手术并发症。在英国，最佳实践关税激励对髋部骨折患者的谵妄进行筛查。此外，国家髋关节骨折数据库（NHFD）的一项绩效指标是降低 POD 的发生率。为了帮助识别，我们试图确定与髋部骨折患者 POD 和 POCD 相关的因素。
我们查阅了 2016 年至 2018 年我院就诊的髋部骨折患者的 NHFD 数据。使用 NHFD 和英国卫生部推荐的 4AT 评分来确定 POD。POCD 定义为简明精神状态测试（AMTS）下降两个或更多。使用逻辑回归，我们调整了协变量，以确定与 POD 和 POCD 相关的因素。
在研究期间，1224 名患者中，有 1023 名患者有完整的数据集进行最终分析。242 名患者（25%）出现 POD。多变量分析仅术前 AMTS 和美国麻醉师协会（ASA）分级是 POD 的独立预测因素。AMTS 每增加 1 分，发生 POD 的几率就会下降 0.60 倍（95%置信区间（CI）0.56 至 0.63，p<0.001）。ASA 每增加一级，发生 POD 的几率就会增加 1.7 倍（95%CI 1.13 至 2.50，p=0.009）。术前 AMTS 低于 8 分强烈预测 POD，其受试者工作特征曲线下面积为 0.86（95%CI 0.84 至 0.89）。只有 ASA 预测 POCD-ASA 每增加一级，发生 POCD 的几率就会增加 2.6 倍（95%CI 1.7 至 4.0，p<0.001）。
POD 和 POCD 在髋部骨折患者中很常见。术前 AMTS 和 ASA 是 POD 的强预测因素，而 ASA 是 POCD 的预测因素。这可能有助于更早地识别出那些风险最大、最适合患者知情同意和决策过程的患者。引用本文：2020；102-B（12）：1675-1681。
