Department of Anesthesiology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, People's Republic of China.
Clin Interv Aging. 2021 May 17;16:823-831. doi: 10.2147/CIA.S303800. eCollection 2021.
To determine the relationships between postoperative delirium (POD) and postoperative activities of daily living (ADL) and mortality in patients undergoing laryngectomy. We hypothesized that POD would reduce postoperative ADL and increase postoperative mortality.
The prospective study included older participants (age ≥65 y) undergoing total laryngectomy, partial laryngectomy, total laryngectomy plus neck dissection, or partial laryngectomy plus neck dissection under general anesthesia. The diagnosis of delirium was based on the Confusion Assessment Method algorithm, which was administered on postoperative days 1 through 6. ADL were evaluated using the Chinese version of the Index of ADL scale. Follow-up assessments of ADL and mortality were conducted 24 months after surgery.
Of 127 participants (aged 70.3 ± 4.1 y), 19 (15.0%) developed POD. POD was not associated with a decrease in ADL after laryngectomy (p=0.599) nor with an increase in postoperative mortality [3/19 (15.8%) vs 12/108 (11.1%), p=0.560, Log rank test]. However, longer surgery duration was significantly associated with worse overall survival (OR, 3.262; 95% CI, 1.261-9.169, p=0.025).
POD was not associated with long-term ADL or mortality after laryngectomy. Prolonged surgery was the only factor associated with a higher postoperative mortality rate.
探讨喉切除术患者术后谵妄（POD）与术后日常生活活动（ADL）和死亡率之间的关系。我们假设 POD 会降低术后 ADL，并增加术后死亡率。
本前瞻性研究纳入了年龄≥65 岁的患者，他们接受了全喉切除术、部分喉切除术、全喉切除术加颈部清扫术或部分喉切除术加颈部清扫术，均采用全身麻醉。谵妄的诊断基于谵妄评估方法（CAM）算法，在术后第 1 天至第 6 天进行评估。ADL 使用中文版日常生活活动量表（ADL）进行评估。术后 24 个月对 ADL 和死亡率进行随访评估。
127 名参与者（年龄 70.3±4.1 岁）中，19 名（15.0%）发生了 POD。POD 与喉切除术后 ADL 下降无关（p=0.599），也与术后死亡率增加无关[19 名（15.8%）与 108 名（11.1%）相比，p=0.560，Log rank 检验]。然而，手术时间较长与总体生存率显著降低相关（OR，3.262；95%CI，1.261-9.169，p=0.025）。
POD 与喉切除术后的长期 ADL 或死亡率无关。手术时间延长是唯一与术后死亡率升高相关的因素。
