Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Colon and Rectal Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Biomed J. 2023 Aug;46(4):100557. doi: 10.1016/j.bj.2022.08.003. Epub 2022 Aug 17.
Postoperative delirium (POD) is a common surgical complication in elderly patients. As frailty is a relatively novel concept, its clinical significance for POD has seldom been examined. This study aimed to investigate the association between frailty and POD in aged cancer patients undergoing elective abdominal surgery in Taiwan.
We prospectively enrolled 345 consecutive patients aged ≥65 years with newly diagnosed cancer who underwent elective abdominal surgery between 2016 and 2018. Frailty assessment was performed using the Comprehensive Geriatric Assessment (CGA). POD was assessed daily using the Confusion Assessment Method from postoperative day 1 until discharge. Patients were allocated into fit and frail groups.
POD occurred in 19 (5.5%) of 345 patients. POD incidence was 1.6%, 3.1%, 4.8%, 11.5%, and 10.0% in patients with 0, 1, 2, 3, and 4+ frail conditions, respectively, which presented a positive linear correlation among patients with an increased number of frail conditions and POD incidence. Based on CGA, 159 (46.1%) and 186 (53.9%) patients were allocated to fit and frail groups, respectively. POD incidence was 2.5% and 8.1% for the fit and frail groups, respectively. Frailty status was an independent risk factor for POD occurrence in multivariate analysis.
Our study identified frailty as an independent risk factor for POD in aged Taiwanese cancer patients undergoing elective abdominal surgery. Given the high prevalence of frailty among older cancer patients, preoperative assessment is important to identify high risk of POD and to improve the quality of postoperative care.
术后谵妄（POD）是老年患者常见的手术并发症。由于衰弱是一个相对较新的概念，其与 POD 的临床意义尚未被充分研究。本研究旨在探讨衰弱与台湾择期腹部手术老年癌症患者 POD 的关系。
我们前瞻性纳入了 2016 年至 2018 年间接受择期腹部手术的 345 例年龄≥65 岁的新诊断癌症患者。使用综合老年评估（CGA）进行衰弱评估。术后第 1 天至出院期间每天使用意识混乱评估方法（CAM）评估 POD。患者分为健康和衰弱两组。
345 例患者中 19 例（5.5%）发生 POD。POD 发生率分别为 0、1、2、3 和 4+衰弱条件的患者中为 1.6%、3.1%、4.8%、11.5%和 10.0%，随着衰弱条件的增加，患者 POD 发生率呈正线性相关。根据 CGA，159 例（46.1%）和 186 例（53.9%）患者分别被分到健康和衰弱组。健康和衰弱组 POD 发生率分别为 2.5%和 8.1%。在多因素分析中，衰弱状态是 POD 发生的独立危险因素。
本研究发现衰弱是台湾择期腹部手术老年癌症患者 POD 的独立危险因素。鉴于老年癌症患者衰弱的高发率，术前评估对于识别 POD 高危患者和提高术后护理质量非常重要。
