Department of Anaesthesiology and Intensive Care, Ankara University Faculty of Medicine, Ibni Sina Hospital, Ankara, Turkey; Ankara University Brain Research Center (AÜBAUM), Ankara, Turkey.
Department of Anesthesia and Intensive Care, Hospital of Nykøbing Falster, Nykøbing Falster, Denmark.
J Clin Anesth. 2024 Oct;97:111506. doi: 10.1016/j.jclinane.2024.111506. Epub 2024 Jul 6.
Postoperative delirium (POD) following surgery is a prevalent and distressing condition associated with adverse patient outcomes and an increased healthcare burden.
To assess the effectiveness of the Safe Brain Initiative care bundle (SBI-CB) in reducing POD in the postanesthesia care unit (PACU).
A multicenter, quality-improvement initiative with retrospective analysis of collected data.
The study was conducted in the operating rooms and postanesthesia care units (PACUs) of four hospitals across Denmark and Turkey.
The convenience sample of patients were aged ≥18 years, scheduled for surgery, and could communicate verbally. Age, sex, preoperative delirium, and the American Society for Anesthesiology physical status classification were used in statistical methods to control for potential confounding influences.
The SBI-CB, 18 delirium-reducing recommendations aligned with international guidelines. The intervention included patient education, staff training, coordination meetings across centers, and a dashboard for the monitoring of outcomes in the PACU.
The primary outcome was the POD trend in the PACU during implementation months, assessed through Nu-DESC screening at up to three time points in the PACU. We also examined the length of hospital stay.
Data were collected from 18,697 adult patients across four hospitals. Initial POD incidence in the PACU after the first three months was 16.36% across all sites (n = 1021). POD in the PACU was observed across all age groups, with peak incidence in younger (18-35 years) and older (>75 years) patients. General anesthesia and longer surgical duration (>1 h) were identified as significant risk factors for POD in the PACU. Matched patients who experienced POD in the PACU had longer stays in hospital, with a mean increase from 35 to 69 h (p < 0.001). Implementation of the SBI-CB was associated with a decreased risk of POD in the PACU for each month of SBI-CB implementation (adjusted odds ratio 0.96, 95% confidence interval: [0.94, 0.97], p < 0.001).
The presented pragmatic implementation of a multidisciplinary care bundle, encompassing pre-, intra-, and postoperative measures alongside outcome monitoring, has the potential to significantly reduce the incidence of POD in the PACU. Improved patient outcomes may be achieved for general surgical departments with patient cohorts not typically considered at risk for developing POD.
Clinicaltrials.gov, identifier NCT05765162.
手术后谵妄（POD）是一种普遍存在且令人痛苦的病症，与患者预后不良和医疗保健负担增加有关。
评估安全大脑倡议护理包（SBI-CB）在减少麻醉后护理单元（PACU）中 POD 的效果。
一项多中心、质量改进计划，对收集的数据进行回顾性分析。
该研究在丹麦和土耳其的四家医院的手术室和麻醉后护理单元（PACU）进行。
患者为年龄≥18 岁、计划接受手术且能够进行口头交流的成年人。年龄、性别、术前谵妄和美国麻醉医师协会身体状况分类在统计学方法中用于控制潜在的混杂影响。
SBI-CB 是 18 项降低谵妄风险的建议，与国际指南一致。干预措施包括患者教育、员工培训、中心之间的协调会议以及 PACU 中结果监测的仪表板。
主要结果是 PACU 中 POD 的趋势，通过在 PACU 中最多三个时间点进行 Nu-DESC 筛查进行评估。我们还检查了住院时间。
来自四家医院的 18697 名成年患者的数据被收集。所有站点（n=1021）在第一个三个月后的 PACU 中初始 POD 发生率为 16.36%。在所有年龄组中都观察到 PACU 中的 POD，在年轻（18-35 岁）和年长（>75 岁）患者中发病率最高。全身麻醉和较长的手术时间（>1 小时）被确定为 PACU 中 POD 的显著危险因素。在 PACU 中经历 POD 的匹配患者的住院时间更长，平均从 35 小时增加到 69 小时（p<0.001）。实施 SBI-CB 与 PACU 中 POD 的风险降低相关，实施 SBI-CB 的每个月风险降低（调整后的优势比 0.96，95%置信区间：[0.94，0.97]，p<0.001）。
呈现的多学科护理包的实用实施，包括术前、术中和术后措施以及结果监测，有可能显著降低 PACU 中 POD 的发生率。对于普通外科部门来说，可能会为那些通常不被认为有发生 POD 风险的患者群体带来更好的患者预后。
Clinicaltrials.gov，标识符 NCT05765162。
