Ding Yinyin, Gao Ju, Ge Yali, Huang Tianfeng, Zhang Yang
Department of Anesthesiology, North Jiangsu people's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, China.
Front Cardiovasc Med. 2024 Aug 7;11:1425621. doi: 10.3389/fcvm.2024.1425621. eCollection 2024.
To identify the risk factors for postoperative delirium (POD) after cardiac surgery in frail elderly patients and develop a receiver operating characteristic (ROC) prediction model to confirm the effectiveness.
This was a prospective observational study, patients were assessed preoperatively according to the frailty index (FI) scale. Cerebral (SctO) was assessed at different time points using near-infrared spectroscopy (NIRS). On the basis of the occurrence of POD within 7 days after surgery, patients were divided into POD and non-POD groups. Risk factors were analyzed using logistic regression analysis, while their predictive values were evaluated using the receiver operating characteristic curve analysis.
POD was significantly associated with frailty, lower preoperative MMSE scores, hyperlipidemia, diabetes, cerebrovascular disease, lower hemoglobin level, lower albumin level, longer operation time, longer CPB time, lower SctO at T5, and lower SctO ( < 0.05). SrtO and SmtO did not differ significantly between groups. FI, preoperative MMSE score, and operation time as independent risk factors ( < 0.05). Significant predictive value was demonstrated in all 3 variables ( < 0.001; respectively). Among them, high sensitivity and specificity were observed with the FI (cut-off value 0.27, sensitivity 75%, specificity 73.5%) and operation time (cut-off value 237.5, sensitivity 62.5%, specificity 78.6%).
The FI, preoperative MMSE score, and operation time were independent risk factors for POD in elderly patients after cardiac surgery, with high predictive value observed with the FI and operation time. Cerebral oxygen saturation was associated with POD but was not an independent risk factor.
Chinese Clinical Trail Registry, No: chictr2200056038.
识别体弱老年患者心脏手术后发生术后谵妄（POD）的危险因素，并建立一个受试者工作特征（ROC）预测模型以证实其有效性。
这是一项前瞻性观察性研究，术前根据衰弱指数（FI）量表对患者进行评估。使用近红外光谱（NIRS）在不同时间点评估脑氧饱和度（SctO）。根据术后7天内POD的发生情况，将患者分为POD组和非POD组。采用逻辑回归分析危险因素，同时使用受试者工作特征曲线分析评估其预测价值。
POD与衰弱、术前MMSE评分较低、高脂血症、糖尿病、脑血管疾病、血红蛋白水平较低、白蛋白水平较低、手术时间较长、体外循环时间较长、T5时SctO较低以及较低的SctO显著相关（P<0.05）。两组之间SrtO和SmtO无显著差异。FI、术前MMSE评分和手术时间为独立危险因素（P<0.05）。所有3个变量均显示出显著的预测价值（P<0.001）。其中，FI（临界值0.27，敏感性75%，特异性73.5%）和手术时间（临界值237.5，敏感性62.5%，特异性78.6%）具有较高的敏感性和特异性。
FI、术前MMSE评分和手术时间是老年心脏手术后患者发生POD的独立危险因素，FI和手术时间具有较高的预测价值。脑氧饱和度与POD相关，但不是独立危险因素。
中国临床试验注册中心，编号：chictr2200056038。
