Department of Anaesthesiology, University Medical Center Hamburg, Hamburg, Germany.
Institute of Medical Psychology, University Medical Center Hamburg, Hamburg, Germany.
J Cardiothorac Vasc Anesth. 2023 Dec;37(12):2552-2560. doi: 10.1053/j.jvca.2023.08.154. Epub 2023 Sep 7.
Postoperative delirium (POD) remains the most common complication in older adults, with cognitive impairment being the main risk factor. Patients with mild cognitive impairment, in particular, have much to lose from delirium; despite this, their cognitive impairment might be clinically overlooked. Understanding which cognitive domains are particularly predictive in this regard may improve the sensitivity of preoperative testing and allow for a more targeted application of resource-intensive measures to prevent delirium in the perioperative period. The authors conducted this study with the aim of identifying the most indicative cognitive domains.
A secondary analysis of a randomized controlled trial.
At a single center, the University Medical Centre Hamburg in Hamburg, Germany.
Patients ≥60 years without major neurocognitive disorders (dementia, Mini-Mental State Examination score ≤23) scheduled for cardiovascular surgery.
Preoperative neuropsychologic testing and delirium screening were performed twice daily until postoperative day 5. A multiple logistic regression model was applied to determine the predictive ability of test performances for the development of delirium.
A total of 541 patients were included in the analysis; the delirium rate was 15.6%. After controlling for confounders, only low performance within the Trail Making Test B/A (odds ratio [OR] = 1.32; 95% CI: 1.05-1.66) and letter fluency (OR = 0.66; 95% CI: 0.45-0.96) predicted a particularly high risk for delirium development. The discriminative ability of the final multiple logistic regression model to predict POD had an area under the curve of 0.786.
Impairment in the cognitive domains of executive function and language skills associated with memory, inhibition, and access speed seem to be particularly associated with the development of delirium after surgery in adults ≥65 years of age without apparent preoperative neurocognitive impairment.
术后谵妄（POD）仍然是老年人最常见的并发症，认知障碍是主要的危险因素。特别是有轻度认知障碍的患者，谵妄会给他们带来很大的损失；尽管如此，他们的认知障碍可能在临床上被忽视。了解哪些认知领域在这方面具有特别的预测性，可以提高术前测试的敏感性，并更有针对性地应用资源密集型措施来预防围手术期的谵妄。作者进行这项研究的目的是确定最具指示性的认知领域。
一项随机对照试验的二次分析。
德国汉堡汉堡大学医学中心的一个单一中心。
无重大神经认知障碍（痴呆，简易精神状态检查评分≤23）、计划接受心血管手术的≥60 岁患者。
术前神经心理测试和谵妄筛查每天进行两次，直到术后第 5 天。应用多元逻辑回归模型来确定测试表现对谵妄发展的预测能力。
共有 541 名患者纳入分析，谵妄发生率为 15.6%。在控制混杂因素后，只有 Trail Making Test B/A（比值比 [OR] = 1.32；95%置信区间：1.05-1.66）和字母流畅性（OR = 0.66；95%置信区间：0.45-0.96）的低表现预测了谵妄发展的高风险。最终多元逻辑回归模型预测 POD 的判别能力曲线下面积为 0.786。
与记忆、抑制和访问速度相关的执行功能和语言技能认知领域的损害，与 65 岁以上无明显术前神经认知障碍的成年人手术后谵妄的发展特别相关。
