Division of Geriatric Medicine and Gerontology, Department of Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Psychiatry and Behavioral Sciences, the Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Age Ageing. 2024 Aug 6;53(8). doi: 10.1093/ageing/afae168.
The surgical population is ageing and often frail. Frailty increases the risk for poor post-operative outcomes such as delirium, which carries significant morbidity, mortality and cost. Frailty is often measured in a binary manner, limiting pre-operative counselling. The goal of this study was to determine the relationship between categorical frailty severity level and post-operative delirium.
We performed an analysis of a retrospective cohort of older adults from 12 January 2018 to 3 January 2020 admitted to a tertiary medical center for elective surgery. All participants underwent frailty screening prior to inpatient elective surgery with at least two post-operative delirium assessments. Planned ICU admissions were excluded. Procedures were risk-stratified by the Operative Stress Score (OSS). Categorical frailty severity level (Not Frail, Mild, Moderate, and Severe Frailty) was measured using the Edmonton Frail Scale. Delirium was determined using the 4 A's Test and Confusion Assessment Method-Intensive Care Unit.
In sum, 324 patients were included. The overall post-operative delirium incidence was 4.6% (15 individuals), which increased significantly as the categorical frailty severity level increased (2% not frail, 6% mild frailty, 23% moderate frailty; P < 0.001) corresponding to increasing odds of delirium (OR 2.57 [0.62, 10.66] mild vs. not frail; OR 12.10 [3.57, 40.99] moderate vs. not frail).
Incidence of post-operative delirium increases as categorical frailty severity level increases. This suggests that frailty severity should be considered when counselling older adults about their risk for post-operative delirium prior to surgery.
手术人群正在老龄化，且往往身体虚弱。虚弱会增加术后谵妄等不良后果的风险，而谵妄会带来显著的发病率、死亡率和医疗费用。虚弱通常以二元方式进行衡量，限制了术前咨询。本研究的目的是确定分类虚弱严重程度与术后谵妄之间的关系。
我们对 2018 年 1 月 12 日至 2020 年 1 月 3 日期间在一家三级医疗中心接受择期手术的老年患者进行了回顾性队列分析。所有参与者在接受择期住院手术前都接受了虚弱筛查，且至少有两次术后谵妄评估。计划转入 ICU 的患者被排除在外。手术风险通过手术应激评分（OSS）进行分层。使用埃德蒙顿虚弱量表（Edmonton Frail Scale）测量分类虚弱严重程度（非虚弱、轻度虚弱、中度虚弱和重度虚弱）。使用 4A 测试和 ICU 意识模糊评估法确定谵妄。
总共有 324 名患者被纳入研究。总的术后谵妄发生率为 4.6%（15 人），随着分类虚弱严重程度的增加而显著增加（2%非虚弱、6%轻度虚弱、23%中度虚弱；P<0.001），相应的谵妄发生率也随之增加（OR 2.57[0.62, 10.66]轻度 vs.非虚弱；OR 12.10[3.57, 40.99]中度 vs.非虚弱）。
术后谵妄的发生率随着分类虚弱严重程度的增加而增加。这表明，在手术前对老年人进行术后谵妄风险咨询时，应考虑虚弱严重程度。
