Arizumi Fumihiro, Maruo Keishi, Kusuyama Kazuki, Kishima Kazuya, Tachibana Toshiya
Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
Spine Surg Relat Res. 2020 May 11;5(1):16-21. doi: 10.22603/ssrr.2020-0037. eCollection 2021.
Delirium after spine surgery is an important complication; identification of risk factors associated with postoperative delirium (PD) is essential for reducing its incidence. Prophylactic intervention for PD has been reported to be effective. This study aimed to identify risk factors for PD and determine the efficacy of a prevention program using a delirium risk scoring system for PD after spine surgery.
This study was conducted in two stages. First, 294 patients (167 males, 127 females) who underwent spine surgery from 2013 to 2014 were assessed to examine the incidence and risk factors of PD and to establish a novel PD screening tool (Group A). Second, preoperative intervention was performed on 265 patients who underwent surgery from 2016 to 2017 (Group B) for the purpose of preventing PD using a delirium risk scoring system. Outcomes, including PD incidence and rates of adverse events, were compared between Group A and Group B.
A logistic regression analysis revealed that psychiatric disorders (odds ratio [OR] = 10.3, P < 0.001), benzodiazepine use (OR = 4.9, P < 0.001), age > 70 years (OR = 4.2, P < 0.001), hearing loss (OR = 3.7, P = 0.001), and admission to intensive care unit (ICU) (OR = 3.7, P = 0.006) were independent risk factors associated with PD. Based on these results, we established a novel delirium screening tool after spine surgery. PD incidence was significantly higher in Group A than in Group B (22% vs. 13%, P = 0.0008). The occurrence of dangerous behavioral symptoms was significantly higher in Group A than in Group B (66% vs. 40%, P = 0.02). The catheter problem tended to be higher in Group A than in Group B (19% vs. 9%, P = 0.245).
In this study, psychiatric disorders, benzodiazepine use, age > 70 years, hearing loss, and admission to ICU were independent risk factors associated with PD. With the introduction of the delirium risk score, the onset of delirium was delayed, and adverse outcomes of delirium were reduced.
脊柱手术后谵妄是一种重要的并发症；识别与术后谵妄（PD）相关的危险因素对于降低其发生率至关重要。据报道，对PD进行预防性干预是有效的。本研究旨在识别PD的危险因素，并确定使用谵妄风险评分系统预防脊柱手术后PD的项目的有效性。
本研究分两个阶段进行。首先，对2013年至2014年接受脊柱手术的294例患者（167例男性，127例女性）进行评估，以检查PD的发生率和危险因素，并建立一种新的PD筛查工具（A组）。其次，对2016年至2017年接受手术的265例患者（B组）进行术前干预，目的是使用谵妄风险评分系统预防PD。比较A组和B组的结果，包括PD发生率和不良事件发生率。
逻辑回归分析显示，精神疾病（比值比[OR]=10.3，P<0.001）、使用苯二氮䓬类药物（OR=4.9，P<0.001）、年龄>70岁（OR=4.2，P<0.001）、听力损失（OR=3.7，P=0.001）和入住重症监护病房（ICU）（OR=3.7，P=0.006）是与PD相关的独立危险因素。基于这些结果，我们建立了一种新的脊柱手术后谵妄筛查工具。A组的PD发生率显著高于B组（22%对13%，P=0.0008）。A组危险行为症状的发生率显著高于B组（66%对40%，P=0.02）。A组的导管问题发生率高于B组（19%对9%，P=0.245）。
在本研究中，精神疾病、使用苯二氮䓬类药物、年龄>70岁、听力损失和入住ICU是与PD相关的独立危险因素。随着谵妄风险评分的引入，谵妄的发作延迟，谵妄的不良后果减少。
