2019冠状病毒病与癌症手术后的术后神经并发症及抗精神病药物使用之间的关联：一项回顾性研究。
Association between COVID-19 and Postoperative Neurological Complications and Antipsychotic Medication Use after Cancer Surgery: A Retrospective Study.
作者信息
Cata Juan P, Hu Jian, Feng Lei, Chung Caroline, Woodman Scott E, Meyer Larissa A
机构信息
Department of Anesthesiology and Perioperative Medicine, The University of Texas-MD Anderson Cancer Centre, Houston, TX 77030, USA.
Anesthesiology and Surgical Oncology Research Group, Houston, TX 77030, USA.
出版信息
J Pers Med. 2023 Jan 31;13(2):274. doi: 10.3390/jpm13020274.
INTRODUCTION
Millions of Americans infected with the severe acute respiratory syndrome-associated coronavirus-19 (COVID-19) need oncologic surgery. Patients with acute or resolved COVID-19 illness complain of neuropsychiatric symptoms. How surgery affects postoperative neuropsychiatric outcomes such as delirium is unknown. We hypothesize that patients with a history of COVID-19 could have an exaggerated risk of developing postoperative delirium after undergoing major elective oncologic surgery.
METHODS
We conducted a retrospective study to determine the association between COVID-19 status and antipsychotic drugs during postsurgical hospitalization as a surrogate of delirium. Secondary outcomes included 30 days of postoperative complications, length of stay, and mortality. Patients were grouped into pre-pandemic non-COVID-19 and COVID-19-positive groups. A 1:2 propensity score matching was used to minimize bias. A multivariable logistic regression model estimated the effects of important covariates on the use of postoperative psychotic medication.
RESULTS
A total of 6003 patients were included in the study. Pre- and post-propensity score matching demonstrated that a history of preoperative COVID-19 did not increase the risk of antipsychotic medications postoperatively. However, respiratory and overall 30-day complications were higher in COVID-19 individuals than in pre-pandemic non-COVID-19 patients. The multivariate analysis showed that the odds of using postoperative antipsychotic medication use for the patients who had COVID-19 compared to those who did not have the infection were not significantly different.
CONCLUSION
A preoperative diagnosis of COVID-19 did not increase the risk of postoperative antipsychotic medication use or neurological complications. More studies are needed to reproduce our results due to the increased concern of neurological events post-COVID-19 infection.
引言
数百万感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的美国人需要接受肿瘤外科手术。患有急性或已康复的COVID-19疾病的患者会出现神经精神症状。手术如何影响术后神经精神结局，如谵妄，目前尚不清楚。我们假设，有COVID-19病史的患者在接受大型择期肿瘤外科手术后发生术后谵妄的风险可能会增加。
方法
我们进行了一项回顾性研究，以确定COVID-19状态与术后住院期间使用抗精神病药物之间的关联，以此作为谵妄的替代指标。次要结局包括术后30天的并发症、住院时间和死亡率。患者被分为疫情前非COVID-19组和COVID-19阳性组。采用1:2倾向评分匹配以尽量减少偏倚。多变量逻辑回归模型估计了重要协变量对术后使用抗精神病药物的影响。
结果
共有6003名患者纳入研究。倾向评分匹配前后的结果表明，术前有COVID-19病史并不会增加术后使用抗精神病药物的风险。然而，COVID-19患者的呼吸系统和总体30天并发症发生率高于疫情前的非COVID-19患者。多变量分析显示，与未感染COVID-19的患者相比，感染COVID-19的患者术后使用抗精神病药物的几率没有显著差异。
结论
术前诊断为COVID-19并不会增加术后使用抗精神病药物或发生神经系统并发症的风险。由于对COVID-19感染后神经事件的关注度增加，需要更多研究来重现我们的结果。
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