Sun Mingyang, Chen Wan-Ming, Wu Szu-Yuan, Zhang Jiaqiang
Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, China.
Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei 24205, Taiwan.
Brain Commun. 2024 Mar 19;6(2):fcae076. doi: 10.1093/braincomms/fcae076. eCollection 2024.
This study investigates the association between postoperative agitated delirium and the risk of dementia in patients who were cognitively intact before undergoing major inpatient surgery. The study included inpatients aged 20 years or older who underwent major surgery requiring general, epidural, or spinal anaesthesia and hospitalization for over one day in Taiwan between 2008 and 2018. Patients were categorized into two groups based on the presence or absence of postoperative agitated delirium. Propensity score matching was conducted to balance various covariates known to influence dementia risk. The final analysis included 10 932 patients (5466 in each group). Multivariate Cox regression analysis was performed to assess the risk of dementia, and incidence rates and incidence rate ratios were calculated. After Propensity score matching, the study cohort comprised 5467 patients without postoperative agitated delirium and 5467 patients with postoperative agitated delirium. In the multivariate Cox regression analysis, the adjusted hazard ratio for dementia were 1.26 (95% confidence intervals, 1.08-1.46; = 0.003) in the postoperative agitated delirium group compared to the no postoperative agitated delirium group. The incidence rates of dementia was significantly higher in patients with postoperative agitated delirium (97.65 versus 70.85 per 10 000 person-years), with an incidence rate ratio of 1.21 (95% CI: 1.04-1.40). Our study demonstrates a substantial rise in dementia incidence linked to postoperative agitated delirium. These findings stress the need for effective prevention and management strategies. Addressing this issue emerges as a vital clinical approach to reduce subsequent dementia risk, with broad implications for enhancing overall perioperative patient outcomes.
本研究调查了在接受大型住院手术前认知功能正常的患者中，术后激越性谵妄与痴呆风险之间的关联。该研究纳入了2008年至2018年期间在台湾接受需要全身、硬膜外或脊髓麻醉且住院超过一天的大型手术的20岁及以上住院患者。根据术后是否存在激越性谵妄将患者分为两组。进行倾向评分匹配以平衡已知会影响痴呆风险的各种协变量。最终分析纳入了10932例患者（每组5466例）。进行多变量Cox回归分析以评估痴呆风险，并计算发病率和发病率比。倾向评分匹配后，研究队列包括5467例无术后激越性谵妄的患者和5467例有术后激越性谵妄的患者。在多变量Cox回归分析中，与无术后激越性谵妄组相比，术后激越性谵妄组痴呆的调整后风险比为1.26（95%置信区间为1.08 - 1.46；P = 0.003）。术后激越性谵妄患者的痴呆发病率显著更高（每10000人年为97.65例对70.85例），发病率比为1.21（95%CI：1.04 - 1.40）。我们的研究表明，与术后激越性谵妄相关的痴呆发病率大幅上升。这些发现强调了有效预防和管理策略的必要性。解决这一问题成为降低后续痴呆风险的重要临床方法，对改善围手术期患者的整体结局具有广泛意义。
