Dham Bhavpreet, Richard Irene, Schneider Eric B, George Benjamin P
Department of Neurology, University of Rochester Medical Center, Rochester, New York.
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
J Surg Res. 2023 Nov;291:711-719. doi: 10.1016/j.jss.2023.06.051. Epub 2023 Aug 9.
To determine the association of Parkinson disease (PD) and postoperative delirium following common surgical procedures.
We performed a retrospective database analysis of the National Inpatient Sample. We used a matched sample of patients with and without PD who underwent any of ten common surgical procedures in the US, 2005-2014. Primary outcome measure was postoperative delirium for patients with and without PD. Secondary measures included disposition, length of stay, and hospital costs.
There were 3,235,866 patients receiving any of the ten most common operative procedures, 2005-2014. There were 35,743 patients with and without PD matched based on age, sex, elective admission status, Charlson Comorbidity index, and presence of dementia. Median age was 77 y (interquartile range 72-82), median Charlson Comorbidity index was 1 (standard deviation 0-2), 46.6% were female, and 46.8% were admitted electively. The three most common operative procedures were hip arthroplasty (28.5%), knee arthroplasty (16.1%), and percutaneous coronary angioplasty (14.9%). Postoperative delirium was present in 1519 patients with PD compared to 828 matched patients without PD (4.2% versus 2.3%; P < 0.001). The adjusted odds ratio of postoperative delirium for PD compared to the matched cohort without PD was 1.88 (95% confidence interval 1.73-2.05). Those undergoing spinal fusion (adjusted odds ratio 2.99, 95% confidence interval 2.06-4.38) had the greatest odds of delirium. For patients with PD, adjusted length of stay, adjusted hospital costs, and adjusted odds of postacute care facility discharge were greater compared to the matched cohort without PD.
Patients with PD are more likely to develop postoperative delirium and have a more complicated postoperative course with longer length of stay and greater hospitalization costs.
确定帕金森病（PD）与常见外科手术后谵妄之间的关联。
我们对国家住院患者样本进行了回顾性数据库分析。我们使用了2005年至2014年在美国接受十种常见外科手术中任何一种手术的有和没有PD的患者匹配样本。主要结局指标是有和没有PD的患者的术后谵妄。次要指标包括出院情况、住院时间和住院费用。
2005年至2014年，有3,235,866名患者接受了十种最常见的手术中的任何一种。根据年龄、性别、择期入院状态、查尔森合并症指数和痴呆症的存在情况，对35,743名有和没有PD的患者进行了匹配。中位年龄为77岁（四分位间距72 - 82岁），中位查尔森合并症指数为1（标准差0 - 2），46.6%为女性，46.8%为择期入院。三种最常见的手术是髋关节置换术（28.5%）、膝关节置换术（16.1%）和经皮冠状动脉成形术（14.9%）。1519名有PD的患者出现了术后谵妄，而828名匹配的无PD患者出现术后谵妄（4.2%对2.3%；P < 0.001）。与匹配的无PD队列相比，PD患者术后谵妄的调整后优势比为1.88（9
