老年手术患者术后认知功能障碍与医疗保健利用增加相关：来自中上收入国家的前瞻性研究。
Postoperative cognitive dysfunction in older surgical patients associated with increased healthcare utilization: a prospective study from an upper-middle-income country.
机构信息
Division of Geriatrics, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
Department of Medicine, Neurological Institute of Thailand, Bangkok, Thailand.
出版信息
BMC Geriatr. 2022 Mar 16;22(1):213. doi: 10.1186/s12877-022-02873-3.
BACKGROUND
Perioperative neurocognitive disorder includes postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). Concerning inconclusive consequences of POCD compared with POD, we explored the association between either POCD or POD and functional decline as well as healthcare utilization.
METHODS
Patients aged at least 60 years who underwent a major operation were enrolled. POCD was defined as a decrease in the Montreal Cognitive Assessment (MoCA) score (≥ 2) 1 week after surgery. Postoperative delirium (POD) was defined according to the criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The primary outcome was instrumental activities of daily living (IADLs) 3 months after discharge. Secondary outcomes were the length of stay (LOS), hospital cost, and factors that affected functional decline 3 months after surgery. The multivariate model, including potential confounding factors, namely age, gender, surgery type, and postoperative complications, was used to analyze possible factors that influenced a reduction in function, and the results were expressed by using adjusted relative risk (RR) and 95%CI.
RESULTS
Two hundred eighty-nine patients with a mean age of 72 years were enrolled. The incidence of POCD at 1 week was 28.5%. At their 3-month follow-ups, the patients with POCD were not associated with IADL decline. Nevertheless, patients with POCD were more likely to need a prolonged LOS (11 days [1, 46] vs. 8 days [2, 42]; P = 0.01), and incur higher hospital costs (8973.43 USD [3481.69, 11 763.74] vs. 5913.62 USD [332.43, 19 567.33]; P < 0.001). Additionally, the patients experiencing POD demonstrated increased risks of reducing their IADLs (adjusted RR 2.33; 95% CI, 1.15-4.71; P = 0.02).
CONCLUSIONS
POCD at 1 week leaded to increase healthcare utilization in a middle-income country. POD during hospitalization was associated with a decline in function after surgery and increased health care utilization.
TRIAL REGISTRATION
Thai Clinical Trials Registry TCTR20190115001 .
背景
围手术期神经认知障碍包括术后认知功能障碍（POCD）和术后谵妄（POD）。鉴于 POCD 的后果尚不确定，而 POD 的后果则更为明确，我们探讨了 POCD 或 POD 与功能下降以及医疗保健利用之间的关系。
方法
本研究纳入了年龄至少 60 岁的接受大手术的患者。POCD 的定义为手术后 1 周时蒙特利尔认知评估（MoCA）评分下降（≥2）。术后谵妄（POD）的定义符合第五版《精神障碍诊断与统计手册》（DSM-5）的标准。主要结局为出院后 3 个月的工具性日常生活活动（IADLs）。次要结局为住院时间（LOS）、住院费用以及术后 3 个月影响功能下降的因素。采用包括年龄、性别、手术类型和术后并发症等潜在混杂因素的多变量模型，分析可能影响功能下降的因素，并以调整后的相对风险（RR）和 95%CI 表示结果。
结果
本研究共纳入 289 名平均年龄为 72 岁的患者。术后 1 周时 POCD 的发生率为 28.5%。在 3 个月的随访中，POCD 患者的 IADL 下降情况无差异。然而，POCD 患者更有可能需要延长 LOS（11 天[1，46] vs. 8 天[2，42]；P=0.01），并产生更高的住院费用（8973.43 美元[3481.69，11763.74] vs. 5913.62 美元[332.43，19567.33]；P<0.001）。此外，发生 POD 的患者出现 IADL 下降的风险增加（调整 RR 2.33；95%CI，1.15-4.71；P=0.02）。
结论
在中等收入国家，术后 1 周时的 POCD 会导致医疗保健利用率增加。住院期间发生 POD 与术后功能下降和增加医疗保健利用率有关。
试验注册
泰国临床试验注册中心 TCTR20190115001。
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