Department of Nursing, Kumamoto School of Nursing, Kumamoto, Japan.
Department of Psychiatry, Kansai Rosai Hospital, Amagasaki, Japan.
Psychogeriatrics. 2022 Jul;22(4):453-459. doi: 10.1111/psyg.12840. Epub 2022 May 3.
Postoperative delirium is associated with increased mortality. Therefore, it is important to manage delirium during the entire perioperative period. Preoperative anxiety is associated with poor prognosis in postoperative patients who have undergone cardiovascular surgery. This study aims to investigate the relationship between preoperative anxiety and onset of delirium after cardiovascular surgery in elderly patients (aged 65 years or older), considering the individual psychological characteristics, such as personality and stress coping skills in response to anxiety, as confounding factors.
This prospective study included patients aged >65 years in a preoperative state before undergoing cardiovascular surgery. Subjects were divided into two groups based on whether they experienced postoperative delirium, or not. We compared clinical and demographic factors, preoperative psychiatric and psychological factors, and intraoperative and perioperative physical factors between the control and delirium groups. Multiple imputations were used to account for missing data.
Out of 168 subjects enrolled in this study, 26 (15.5%) developed postoperative delirium. Univariate analysis showed significant differences in age (P = 0.027), cognitive function (P = 0.007), agreeableness (P = 0.029), and the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score (P = 0.023) between the delirium and control groups. Multiple logistic regression analysis did not identify a significant association between preoperative anxiety and the onset of postoperative delirium. However, age (odds ratio (OR) = 1.114, P = 0.018), agreeableness (OR = 0.555, P = 0.008), and the APACHE-II score (OR = 1.227, P = 0.008) were identified as risk factors for postoperative delirium.
Agreeableness, one of the personality traits associated with preoperative anxiety, appears to be involved in the development of postoperative delirium as an independent psychological factor, regardless of age or physical factors.
术后谵妄与死亡率增加有关。因此，在整个围手术期管理谵妄非常重要。术前焦虑与接受心血管手术后预后不良的术后患者有关。本研究旨在调查老年患者（年龄≥ 65 岁）术前焦虑与心血管手术后谵妄发作之间的关系，考虑到个体心理特征，如人格和应对焦虑的应激技能，作为混杂因素。
这项前瞻性研究纳入了术前状态下接受心血管手术的年龄> 65 岁的患者。根据是否发生术后谵妄，将患者分为两组。我们比较了对照组和谵妄组的临床和人口统计学因素、术前精神和心理因素以及术中及围手术期生理因素。采用多重插补法处理缺失数据。
本研究共纳入 168 例患者，其中 26 例（15.5%）发生术后谵妄。单因素分析显示，年龄（P=0.027）、认知功能（P=0.007）、宜人性（P=0.029）和急性生理学和慢性健康评估-II（APACHE-II）评分（P=0.023）两组间差异有统计学意义。多因素逻辑回归分析未发现术前焦虑与术后谵妄发生之间存在显著相关性。然而，年龄（比值比（OR）=1.114，P=0.018）、宜人性（OR=0.555，P=0.008）和 APACHE-II 评分（OR=1.227，P=0.008）被确定为术后谵妄的危险因素。
宜人性是与术前焦虑相关的人格特质之一，作为一个独立的心理因素，似乎与术后谵妄的发生有关，而与年龄或身体因素无关。
