Sircar Krishnan, Yagdiran Ayla, Bredow Jan, Annecke Thorsten, Eysel Peer, Scheyerer Max Joseph
Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener-Strasse 62, 50937 Cologne, Germany.
Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Urbacher Weg 19, 51149 Cologne, Germany.
J Clin Orthop Trauma. 2022 Aug 27;33:102000. doi: 10.1016/j.jcot.2022.102000. eCollection 2022 Oct.
Postoperative delirium (PD) is a major concern in geriatric patients undergoing orthopedic surgery. This prospective observational study aims to examine the incidence of PD, to identify intervention-specific risk factors and to investigate the influence of orthopedic surgery on delirium.
From 2019 to 2020, 132 patients ≥70 years of age with endoprosthetic (Group E) or spinal surgery (Group S) were included. Upon admission, the ISAR score, the Nursing Delirium Screening Scale, potential risk factors, the ASA score, duration of surgery, type of anesthesia, blood loss, and hemoglobin drop were recorded. For risk factor analysis patients were grouped into Group D (delirium) and Group ND (no delirium). Primary endpoint was the occurrence of PD.
Of 132 patients, 50 were included in Group E and 82 in Group S. Mean age and ISAR score were not significantly different between groups. Delirium rate in Group E and S was 12% vs. 18% (p = 0.3). Differences could be observed between Group D and ND in duration of surgery (173 min vs. 112 min, p = 0.02), postoperative hemoglobin drop (3.2 g/dl vs. 2.3 g/dl; p = 0.026), history of PD (23% vs. 11%, p = 0.039) and use of isoflurane (6 vs. 2). Type of surgery was not an independent risk factor (p = 0.26).
Specific type of orthopedic surgery is not an independent risk factor for PD. Prevention of PD should focus on duration of surgery and blood loss, particularly in patients with a history of PD. A possible delirogenic potential of isoflurane should be further studied.
术后谵妄（PD）是老年骨科手术患者的一个主要问题。这项前瞻性观察性研究旨在检查PD的发生率，确定特定干预的风险因素，并调查骨科手术对谵妄的影响。
2019年至2020年，纳入了132例年龄≥70岁接受假体植入手术（E组）或脊柱手术（S组）的患者。入院时，记录ISAR评分、护理谵妄筛查量表、潜在风险因素、ASA评分、手术持续时间、麻醉类型、失血量和血红蛋白下降情况。为进行风险因素分析，将患者分为D组（谵妄组）和ND组（无谵妄组）。主要终点是PD的发生情况。
132例患者中，E组50例，S组82例。两组之间的平均年龄和ISAR评分无显著差异。E组和S组的谵妄发生率分别为12%和18%（p = 0.3）。D组和ND组在手术持续时间（173分钟对112分钟，p = 0.02）、术后血红蛋白下降（3.2 g/dl对2.3 g/dl；p = 0.026）、PD病史（23%对11%，p = 0.039）和异氟烷使用情况（6例对2例）方面存在差异。手术类型不是独立的风险因素（p = 0.26）。
特定类型的骨科手术不是PD的独立风险因素。预防PD应关注手术持续时间和失血量，尤其是有PD病史的患者。异氟烷可能的致谵妄潜力应进一步研究。
