Wu Jiayi, Gao Shaojie, Zhang Shuang, Yu Yao, Liu Shangkun, Zhang Zhiguo, Mei Wei
Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China.
Perioper Med (Lond). 2021 Feb 3;10(1):3. doi: 10.1186/s13741-020-00174-0.
Although postoperative delirium is a frequent complication of surgery, little is known about risk factors for delirium occurring in the post-anaesthesia care unit (PACU). The aim of this study was to determine pre- and intraoperative risk factors for the development of recovery room delirium (RRD) in patients undergoing elective non-cardiovascular surgery.
RRD was diagnosed according to the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We collected perioperative data in 228 patients undergoing elective non-cardiovascular surgery under general anaesthesia and performed univariate and multivariate logistic regression to identify risk factors related to RRD. PACU and postoperative events were recorded to assess the outcome of RRD.
Fifty-seven patients (25%) developed RRD. On multivariate analysis, maintenance of anaesthesia with inhalation anaesthetic agents (OR = 6.294, 95% CI 1.4-28.8, corrected p = 0.03), malignant primary disease (OR = 3.464, 95% CI = 1.396-8.592, corrected p = 0.018), American Society of Anaesthesiologists Physical Status (ASA-PS) III-V (OR = 3.389, 95% CI = 1.401-8.201, corrected p = 0.018), elevated serum total or direct bilirubin (OR = 2.535, 95% CI = 1.006-6.388, corrected p = 0.049), and invasive surgery (OR = 2.431, 95% CI = 1.103-5.357, corrected p = 0.035) were identified as independent risk factors for RRD. RRD was associated with higher healthcare costs (31,428 yuan [17,872-43,674] versus 16,555 yuan [12,618-27,788], corrected p = 0.002), a longer median hospital stay (17 days [12-23.5] versus 11 days [9-17], corrected p = 0.002), and a longer postoperative stay (11 days [7-15] versus 7 days [5-10], corrected p = 0.002]).
Identifying patients at high odds for RRD preoperatively would enable the formation of more timely postoperative delirium management programmes.
尽管术后谵妄是手术常见的并发症，但对于麻醉后恢复室（PACU）中发生谵妄的危险因素知之甚少。本研究旨在确定择期非心脏手术患者发生恢复室谵妄（RRD）的术前和术中危险因素。
根据重症监护病房意识模糊评估方法（CAM-ICU）诊断RRD。我们收集了228例接受全身麻醉的择期非心脏手术患者的围手术期数据，并进行单因素和多因素逻辑回归分析以确定与RRD相关的危险因素。记录PACU和术后事件以评估RRD的结局。
57例患者（25%）发生RRD。多因素分析显示，使用吸入麻醉剂维持麻醉（OR = 6.294，95%CI 1.4 - 28.8，校正p = 0.03）、恶性原发性疾病（OR = 3.464，95%CI = 1.396 - 8.592，校正p = 0.018）、美国麻醉医师协会身体状况分级（ASA-PS）III - V级（OR = 3.389，95%CI = 1.401 - 8.201，校正p = 0.018）、血清总胆红素或直接胆红素升高（OR = 2.535，95%CI = 1.006 - 6.388，校正p = 0.049）以及侵入性手术（OR = 2.431，95%CI = 1.103 - 5.357，校正p = 0.035）被确定为RRD的独立危险因素。RRD与更高的医疗费用相关（31428元[17872 - 43674] vs 16555元[12618 - 27788]，校正p = 0.002）、中位住院时间更长（17天[12 - 23.5] vs 11天[9 - 17]，校正p = 0.002）以及术后住院时间更长（11天[7 - 15] vs 7天[5 - 10]，校正p = 0.002）。
术前识别RRD高风险患者将有助于制定更及时的术后谵妄管理方案。
