Department of Anesthesiology, Hebei General Hospital, Shijiazhuang City, People's Republic of China.
Graduate Faculty, Hebei North University, Zhangjiakou City, People's Republic of China.
Clin Interv Aging. 2023 Jan 19;18:81-92. doi: 10.2147/CIA.S395893. eCollection 2023.
This study was to investigate the incidence and potential predictive factors for postoperative delirium (POD) in older people following urinary calculi surgery, and to establish the corresponding risk stratification score by the significant factors to predict the risk of POD.
We retrospectively analyzed the perioperative data of 195 patients aged 65 or older who underwent elective urinary calculi surgery between September 2020 and September 2022. POD was defined by chart-based method, and the serum uric acid to creatinine (SUA/Cr) ratio as well as neutrophil-to-lymphocyte ratio (NLR) were calculated, respectively. Identification of the risk factors for POD was performed by univariate and multivariate logistic regression analysis. Moreover, the risk stratification score was developed based on the regression coefficients of the associated variables.
In 195 eligible patients following urinary calculi surgery, the median age was 69 (66-72) and 19 patients ultimately developed POD (9.7%). The results by univariate analysis showed that patients with advanced age, high American Society of Anesthesiologists (ASA) physical status (≥3) and low SUA/Cr ratio (≤3.3) were more likely to develop POD, but dexmedetomidine can significantly decrease the risk of the occurrence of POD. The multivariate analysis further indicated that high ASA physical status (≥3) and low SUA/Cr ratio (≤3.3) were independently associated with POD, and the POD incidence could obviously be elevated with the increase of risk stratification score. Moreover, patients with delirium had longer hospital stays.
POD is frequent in geriatric patients following urinary calculi surgery (9.7%). The high ASA physical status (≥3) and low SUA/Cr ratio (≤3.3) were effective predictors of POD. The corresponding risk stratification based on these factors could be beneficial to determining patients who are susceptible to POD, and thus better preventing and reducing the occurrence of POD. However, large prospective studies are needed to confirm this finding.
本研究旨在探讨老年人行尿路结石手术后发生术后谵妄（POD）的发生率及潜在预测因素，并通过有意义的因素建立相应的风险分层评分来预测 POD 的风险。
我们回顾性分析了 2020 年 9 月至 2022 年 9 月期间 195 名年龄在 65 岁或以上行择期尿路结石手术的患者的围手术期数据。通过图表法定义 POD，计算血清尿酸肌酐（SUA/Cr）比值和中性粒细胞与淋巴细胞比值（NLR）。通过单因素和多因素逻辑回归分析确定 POD 的危险因素。此外，根据相关变量的回归系数建立风险分层评分。
在 195 名符合条件的尿路结石手术后患者中，中位年龄为 69（66-72）岁，19 名患者最终发生 POD（9.7%）。单因素分析结果显示，年龄较大、美国麻醉医师协会（ASA）身体状况较高（≥3）和 SUA/Cr 比值较低（≤3.3）的患者更有可能发生 POD，但右美托咪定可显著降低 POD 的发生风险。多因素分析进一步表明，ASA 身体状况较高（≥3）和 SUA/Cr 比值较低（≤3.3）与 POD 独立相关，且风险分层评分的增加可明显提高 POD 发生率。此外，发生谵妄的患者住院时间较长。
老年人行尿路结石手术后 POD 发生率较高（9.7%）。较高的 ASA 身体状况（≥3）和较低的 SUA/Cr 比值（≤3.3）是 POD 的有效预测指标。基于这些因素的相应风险分层有助于确定易发生 POD 的患者，从而更好地预防和减少 POD 的发生。但是，需要更大规模的前瞻性研究来证实这一发现。
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