Kolk Andreas, Schwarzer Claudia, Wolff Klaus-Dietrich, Grill Florian, Weingart Julia
Senior Executive Surgeon (formerly), Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany; Head of Department of Oral and Maxillofacial Surgery, Medical University Innsbruck, Innsbruck, Austria.
Senior resident, Department of Oral- and Craniomaxillofacial Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
J Oral Maxillofac Surg. 2022 Feb;80(2):372-379.e5. doi: 10.1016/j.joms.2021.08.153. Epub 2021 Aug 25.
Postoperative delirium (PD) is a common and severe complication, following extensive surgery and prolonged stays in intensive care units (ICU). The study aimed to estimate the frequency of and identify risk factors for PD in a unified sample of head and neck surgery patients.
The investigators implemented a retrospective cohort study composing of patients undergoing free flap reconstructive surgery over 1 year. The predictor variables were identified as 146 general and periprocedural parameters. The primary outcome variable was PD (+ or -). Descriptive and bivariate statistics were performed to identify existing correlations between the predictive factors and PD and the P-value was set at .05. A logistic regression model (LRM) was created to adjust for possible confounding factors and reveal possible independent prognostic factors for the onset of PD.
Hundred patients (group 1, 18 with PD+, group 2, 82 without PD) undergoing microvascular free flap (65 males, 35 females, mean age = 65 [range 18 to 84 years]) surgery were recruited. The investigators identified 15 variables that were statistically associated with PD. In the LRM, after adjusting for age, diabetes status, and preoperative TSH, free fibula transplants (FT) as type of surgery was associated with an increased risk for PD (FT, Odds Ratio (OR) 6.3 (1.6 to 25.7, P = .01).
The investigators identified 15 variables associated with an increased risk of developing PD, one of which had a statistically significant association after adjusting for other variables in a LRM. Future research efforts should be devoted to assessing the use of these variables for predicting PD further. Since the use of FT showed to be an independent prognostic parameter for the development of PD in this study, patients receiving FT should get special attention in the first days after surgery to prevent PD and associated complications such as increased mortality and prolonged hospital stays.
术后谵妄（PD）是一种常见且严重的并发症，常见于大型手术后以及在重症监护病房（ICU）长时间停留之后。本研究旨在评估头颈外科手术患者统一样本中PD的发生率并确定其风险因素。
研究人员开展了一项回顾性队列研究，纳入了1年内接受游离皮瓣重建手术的患者。预测变量确定为146个一般和围手术期参数。主要结局变量为PD（阳性或阴性）。进行描述性和双变量统计以确定预测因素与PD之间的现有相关性，P值设定为0.05。创建逻辑回归模型（LRM）以调整可能的混杂因素，并揭示PD发生的可能独立预后因素。
招募了100例接受微血管游离皮瓣手术的患者（第1组，18例PD阳性，第2组，82例无PD）（65例男性，35例女性，平均年龄 = 65岁[范围18至84岁]）。研究人员确定了15个与PD有统计学关联的变量。在LRM中，在调整年龄、糖尿病状态和术前促甲状腺激素后，游离腓骨移植（FT）作为手术类型与PD风险增加相关（FT，优势比（OR）6.3（1.6至25.7，P = 0.01）。
研究人员确定了15个与发生PD风险增加相关的变量，其中一个在LRM中调整其他变量后具有统计学意义的关联。未来的研究应致力于进一步评估这些变量用于预测PD的用途。由于本研究中使用FT显示是PD发生的独立预后参数，接受FT的患者在术后头几天应得到特别关注，以预防PD及相关并发症，如死亡率增加和住院时间延长。
