在老年骨科护理路径中，髋部骨折患者围手术期用药与术后谵妄之间不存在关联。

Lack of Association Between Perioperative Medication and Postoperative Delirium in Hip Fracture Patients in an Orthogeriatric Care Pathway.

作者信息

Genet Bastien, Lamy Tina, Cohen-Bittan Judith, Glasman Pauline, Verny Marc, Riou Bruno, Boddaert Jacques, Zerah Lorène

机构信息

Department of Geriatric Medicine, Unit of Peri-Operative Geriatric Care, Assistance Publique Hôpitaux de Paris (APHP), Hôpital la Pitié-Salpêtrière, Paris, France.

出版信息

J Am Med Dir Assoc. 2022 Apr;23(4):623-630.e2. doi: 10.1016/j.jamda.2021.09.022. Epub 2021 Oct 13.

DOI:10.1016/j.jamda.2021.09.022

PMID:34653382

Abstract

OBJECTIVES

Units for perioperative geriatric care are playing a growing role in the care of older patients after hip fracture surgery. Postoperative delirium is one of the most common complications after hip fracture, but no study has assessed the impact of therapeutics received during a dedicated orthogeriatric care pathway on its incidence. Our main objective was to assess the association between drugs used in emergency, operating, and recovery departments and postoperative delirium during the acute stay.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

All patients ≥70 years old admitted for hip fracture to the emergency department and hospitalized in our unit for perioperative geriatric care after hip fracture surgery under general anesthesia between July 2009 and December 2019 in an academic hospital in Paris.

METHODS

Demographic, clinical, and biological data and all medications administered pre-, peri-, and postoperatively were prospectively collected by 3 geriatricians. Postoperative delirium in the unit for perioperative geriatric care was assessed by using the confusion assessment method scale. Logistic regression analysis was used to assess variables independently associated with postoperative delirium.

RESULTS

A total of 490 patients were included [mean (SD) age 87 (6) years]; 215 (44%) had postoperative delirium. The occurrence was not associated with therapeutics administered during the dedicated orthogeriatric care pathway. Probability of postoperative delirium was associated with advanced age [>90 years, odds ratio (OR) 2.03, 95% confidence interval (CI) 1.07-3.89], dementia (OR 3.51, 95% CI 2.14--5.82), depression (OR 1.85, 95% CI 1.14-3.01), and preoperative use of beta-blockers (OR 1.75, 95% CI 1.10-2.79).

CONCLUSIONS AND IMPLICATIONS

No emergency or anesthetic drugs were significantly associated with postoperative delirium. Further studies are needed to demonstrate a possible causal link between preoperative use of beta-blockers and postoperative delirium.

摘要

目的

围手术期老年护理单元在髋部骨折手术后老年患者的护理中发挥着越来越重要的作用。术后谵妄是髋部骨折后最常见的并发症之一，但尚无研究评估在专门的老年骨科护理路径中接受的治疗对其发生率的影响。我们的主要目标是评估急诊、手术和恢复科室使用的药物与急性住院期间术后谵妄之间的关联。

设计

回顾性队列研究。

设置与参与者

2009年7月至2019年12月期间，在巴黎一家学术医院，所有年龄≥70岁因髋部骨折入住急诊科并在全身麻醉下接受髋部骨折手术后在我们单位接受围手术期老年护理的患者。

方法

3名老年病科医生前瞻性收集人口统计学、临床和生物学数据以及术前、术中和术后使用的所有药物。使用意识错乱评估方法量表评估围手术期老年护理单元的术后谵妄。采用逻辑回归分析评估与术后谵妄独立相关的变量。

结果

共纳入490例患者[平均（标准差）年龄87（6）岁]；215例（44%）发生术后谵妄。其发生与在专门的老年骨科护理路径中给予的治疗无关。术后谵妄的概率与高龄[>90岁，比值比（OR）2.03，95%置信区间（CI）1.07 - 3.89]、痴呆（OR 3.51，95% CI 2.14 - 5.82）、抑郁（OR 1.85，95% CI 1.14 - 3.01）以及术前使用β受体阻滞剂（OR 1.75，95% CI 1.10 - 2.79）有关。