Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
BMC Geriatr. 2022 Jul 15;22(1):585. doi: 10.1186/s12877-022-03252-8.
Frailty has been associated with postoperative delirium (POD). Studies suggest that the Fried phenotype has a stronger association with POD than the Edmonton Frailty Scale (EFS) criteria. Although phenotypic frailty is recognized as a good predictor of delirium, the EFS has higher ratings for feasibility in the surgical setting. Thus, our aim was to determine the association between EFS-assessed vulnerability and POD in an elective surgical population of older adults. A secondary aim was to determine which domains assessed by the EFS were closely associated with POD.
After IRB approval was received, electronic medical records of surgical patients at our institution were downloaded from 12/1/2018 to 3/1/2020. Inclusion criteria included age ≥ 65 years, preoperative EFS assessment within 6 months of surgery, elective surgery not scheduled for intensive care unit (ICU) stay but followed by at least 1 day postoperative stay, and at least two in-hospital evaluations with the 4 A's test (arousal, attention, abbreviated mental test-4, acute change [4AT]) on the surgical ward. Vulnerability was determined by EFS score ≥ 6. Patients were stratified into two groups according to highest postoperative 4AT score: 0-3 (no POD) and ≥ 4 (POD). Odds of POD associated with EFS score ≥ 6 were evaluated by using logistic regression adjusted for potential confounders.
The dataset included 324 patients. Vulnerability was associated with higher incidence of POD (p = 0.0007, Fisher's exact). EFS ≥6 was consistently associated with POD in all bivariate models. Vulnerability predicted POD in multivariable modeling (OR = 3.5, 95% CI 1.1 to 11.5). Multivariable analysis of EFS domains revealed an overall trend in which higher scores per domain had a higher odds for POD. The strongest association occurred with presence of incontinence (OR = 3.8, 95% CI 1.2 to 11.0).
EFS criteria for vulnerability predict POD in older, non-ICU patients undergoing elective surgery.
衰弱与术后谵妄（POD）有关。研究表明，与埃德蒙顿衰弱量表（EFS）标准相比，Fried 表型与 POD 的关联更强。尽管表型衰弱被认为是谵妄的良好预测指标，但 EFS 在手术环境中的可行性评分更高。因此，我们的目的是确定在接受择期手术的老年人群中，EFS 评估的脆弱性与 POD 之间的关联。次要目的是确定 EFS 评估的哪些领域与 POD 密切相关。
在获得 IRB 批准后，从我们机构的手术患者的电子病历中下载了 2018 年 12 月 1 日至 2020 年 3 月 1 日的数据。纳入标准包括年龄≥65 岁，术前 6 个月内接受 EFS 评估，择期手术不安排入住重症监护病房（ICU），但术后至少有 1 天的住院治疗，以及在外科病房至少有两次使用 4A 测试（觉醒、注意力、简易精神状态测试-4、急性变化[4AT]）的评估。脆弱性通过 EFS 评分≥6 确定。根据术后最高 4AT 评分将患者分为两组：0-3（无 POD）和≥4（POD）。使用调整潜在混杂因素的逻辑回归评估 EFS 评分≥6 与 POD 相关的可能性。
数据集包括 324 名患者。脆弱性与较高的 POD 发生率相关（p=0.0007，Fisher 精确检验）。EFS≥6 在所有双变量模型中均与 POD 相关。脆弱性在多变量模型中预测 POD（OR=3.5，95%CI 1.1 至 11.5）。EFS 各领域的多变量分析显示，各领域评分越高，POD 的可能性越大。最强的关联发生在存在尿失禁的情况下（OR=3.8，95%CI 1.2 至 11.0）。
EFS 脆弱性标准可预测接受择期手术的老年非 ICU 患者的 POD。
