School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, People's Republic of China.
Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China.
Clin Interv Aging. 2022 Sep 1;17:1331-1342. doi: 10.2147/CIA.S380234. eCollection 2022.
Early and accurate prediction of elderly patients at high risk of postoperative cognitive dysfunction (POCD) after non-cardiac surgery will provide favorable evidence for rational perioperative management and long-term postoperative recovery. This study aimed to develop bedside dynamic nomograms to provide accurately an individualized prediction of the risk of POCD at 6-month postoperatively with patients undergoing non-cardiac surgery and to guide clinical decision-making and postoperative management.
We retrospectively collected patients undergoing surgical treatment at the Nanjing First Hospital between May 2020 and May 2021. We collected the data on preoperative, intraoperative, and postoperative variables. Clinical and laboratory data on admission and intraoperative variables and postoperative variables were used. We measured the performances of the nomograms using sensitivity, specificity of the receiver operating characteristic (ROC), the area under the ROC curves (AUC), the 10-fold cross-validation, and decision curve analysis (DCA).
POCD was observed in 23 of 415 patients (5.6%) at 6-month postoperatively. The preoperative and postoperative models obtained 91.6% and 94.0% accuracy rates on the data. Compared to the preoperative model, the postoperative model had an area under the receiver characteristic curve (AUC) of 0.973 vs 0.947, corresponding to a specificity of 0.941 vs 0.918 and a sensitivity of 0.913 vs 0.870. The overall performance of the postoperative model was better than the preoperative model.
In this study, we developed novel bedside dynamic nomograms with reasonable clinical utility that can provide individualized prediction of POCD risk at 6-month postoperatively in elderly patients undergoing non-cardiac surgery at different time points based on patient admission and postoperative data. External validations are needed to ensure their value in predicting POCD in elderly patients.
对非心脏手术后发生术后认知功能障碍（POCD）高危的老年患者进行早期、准确预测，可为合理围手术期管理和术后长期恢复提供有利证据。本研究旨在建立床边动态列线图，为接受非心脏手术的患者提供术后 6 个月 POCD 风险的个体化预测，指导临床决策和术后管理。
我们回顾性收集了 2020 年 5 月至 2021 年 5 月在南京市第一医院接受手术治疗的患者。我们收集了术前、术中、术后变量的数据。使用入院和术中变量以及术后变量的临床和实验室数据。我们使用灵敏度、受试者工作特征（ROC）曲线的特异性、ROC 曲线下面积（AUC）、10 倍交叉验证和决策曲线分析（DCA）来衡量列线图的性能。
术后 6 个月时，415 例患者中有 23 例（5.6%）发生 POCD。术前和术后模型在数据上的准确率分别为 91.6%和 94.0%。与术前模型相比，术后模型的受试者特征曲线下面积（AUC）为 0.973 对 0.947，对应的特异性为 0.941 对 0.918，灵敏度为 0.913 对 0.870。术后模型的整体性能优于术前模型。
在这项研究中，我们开发了一种新的床边动态列线图，具有合理的临床实用性，可以根据患者入院和术后数据，在不同时间点为接受非心脏手术的老年患者提供术后 6 个月 POCD 风险的个体化预测。需要进行外部验证，以确保其在预测老年患者 POCD 中的价值。
