用于预测重大泌尿外科癌症手术后术后谵妄的 G8 和 IADL 改良 G8 筛查工具的预测价值。

Predictive value of the G8 and the IADL-modified G8 screening tools for postoperative delirium following major urological cancer surgery.

机构信息

National Cancer Center Hospital East, Chiba, Japan.

出版信息

J Geriatr Oncol. 2022 Nov;13(8):1188-1193. doi: 10.1016/j.jgo.2022.08.014. Epub 2022 Aug 26.

DOI:10.1016/j.jgo.2022.08.014

PMID:36038466

Abstract

INTRODUCTION

The purpose of this study was to evaluate whether the Geriatric-8 (G8) and the instrumental activities of daily living (IADL)-modified G8 are associated with the occurrence of postoperative delirium after major urological cancer surgery.

MATERIALS AND METHODS

We retrospectively analyzed a total of 415 consecutive patients who underwent major urologic cancer surgery and were screened preoperatively using the G8 and the IADL-modified G8 at our institution between January 2020 and July 2021. For both the G8 and the IADL-modified G8, a cut-off value of 14 was used. All patients underwent perioperative management according to the Enhanced Recovery After Surgery protocol formulated at our institution. Delirium was diagnosed using the Confusion Assessment Method. The relationship between these screening tests and clinical variables was examined. Predictive accuracy was evaluated by the area under the receiver operating characteristic curve (AUC). To determine the risk factors for the occurrence of postoperative delirium, univariate and multivariate analyses were performed.

RESULTS

Of the 415 patients, 160 (39%) were assigned to the low G8 (score ≤ 14) group and 166 (40%) to the low IADL-modified G8 (score ≤ 14) group. The median age of the patients was 72 years. Postoperative delirium occurred in 31 patients (7%). The AUC values for predicting postoperative delirium were 0.69 for the G8 and 0.71 for the IADL-modified G8. Multivariate analysis for the G8 showed that G8 ≤ 14 (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.2-6.0; P = 0.02), preoperative use of benzodiazepine (OR = 3.8; 95% CI = 1.6-8.6; P = 0.002), and operative time ≥ 237 min (OR = 3.3; 95% CI = 1.5-7.1; P = 0.003) were independent risk factors for postoperative delirium. Similarly, for the IADL-modified G8, IADL-modified G8 ≤ 14 (OR = 2.6; 95% CI = 1.1-5.8; P = 0.02), preoperative use of benzodiazepine (OR = 3.9; 95% CI = 1.7-8.8; P = 0.001), and operative time ≥ 237 min (OR = 3.3; 95% CI = 1.5-7.2; P = 0.003) were independent risk factors for postoperative delirium.

DISCUSSION

The G8 and the IADL-modified G8 screening may allow for better identification of patients at risk of postoperative delirium.

摘要

介绍

本研究旨在评估老年-8 项（G8）和改良后的工具性日常生活活动（IADL）-G8 是否与大泌尿外科癌症手术后发生术后谵妄有关。

材料和方法

我们回顾性分析了 2020 年 1 月至 2021 年 7 月在我院接受大泌尿科癌症手术并在术前使用 G8 和改良后的 IADL-G8 进行筛查的 415 例连续患者。对于 G8 和改良后的 IADL-G8，使用 14 作为截断值。所有患者均根据我院制定的术后恢复加速康复方案进行围手术期管理。使用意识混乱评估方法诊断谵妄。检查这些筛选测试与临床变量之间的关系。通过接收者操作特征曲线下面积（AUC）评估预测准确性。为了确定术后谵妄发生的危险因素，进行了单变量和多变量分析。

结果

在 415 名患者中，160 名（39%）被分配到低 G8（评分≤14）组，166 名（40%）被分配到低改良后的 IADL-G8（评分≤14）组。患者的中位年龄为 72 岁。31 名患者（7%）发生术后谵妄。G8 预测术后谵妄的 AUC 值为 0.69，改良后的 IADL-G8 为 0.71。G8 的多变量分析显示，G8≤14（优势比[OR] = 2.6；95%置信区间[CI] = 1.2-6.0；P = 0.02）、术前使用苯二氮䓬类药物（OR = 3.8；95%CI = 1.6-8.6；P = 0.002）和手术时间≥237 分钟（OR = 3.3；95%CI = 1.5-7.1；P = 0.003）是术后谵妄的独立危险因素。同样，对于改良后的 IADL-G8，改良后的 IADL-G8≤14（OR = 2.6；95%CI = 1.1-5.8；P = 0.02）、术前使用苯二氮䓬类药物（OR = 3.9；95%CI = 1.7-8.8；P = 0.001）和手术时间≥237 分钟（OR = 3.3；95%CI = 1.5-7.2；P = 0.003）也是术后谵妄的独立危险因素。