Wei Li, Liu Miao, Zhang Shisi, Chen Yujie, Wu Min, Chen Xiaomei, Liu Jia, He Yuxuan, Yang Xue, Xian Jishu
Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
Chongqing Clinical Research Center for Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
BMC Surg. 2024 Oct 1;24(1):272. doi: 10.1186/s12893-024-02573-2.
Preoperative frailty is a risk factor associated with postoperative delirium (POD), which has attracted more attention from clinicians, but no research has shown that it is related to elderly patients undergoing craniotomy. Therefore, the aim of this study was to determine the effect of preoperative frailty on POD in older patients, especially those who underwent craniotomy.
From October 2022 to May 2023, older patients who underwent elective craniotomy were collected. Assess the occurrence of frailty using the FRAIL scale one day before surgery. Evaluate the occurrence of POD using the Confusion Assessment Method (CAM) within three days after surgery. Participants were divided into two groups, one group being POD, Logistic regression analysis was used to find the risk variables for POD, and the predictive value of preoperative frailty to POD was determined by using the operating characteristic curve of the subjects.
A total of 300 patients were included in this study, among whom 83 patients (27.7%) exhibited preoperative frailty and 69 patients (23.0%) experienced POD. The results of the multivariate logistic regression analysis indicate that preoperative frailty (OR: 8.816, 95% CI: 3.972-19.572), preoperative hypoalbuminemia (OR: 0.893, 95% CI: 0.811-0.984), low BMI (OR: 0.793, 95% CI: 0.698-0.901), and prolonged operative duration (OR: 1.007, 95% CI: 1.004-1.010) are independent risk factors for POD in older patients who underwent craniotomy. We constructed a risk prediction model using these factors, which had an area under the ROC curve of 0.908 (95% CI: 0.869-0.947, P < 0.001). Preoperative frailty enhanced the discriminative ability of the prediction model by 0.037. POD was associated with a longer length of hospital stay and higher hospitalization costs.
Preoperative frailty is an independent risk factor for POD in older patients undergoing elective craniotomy and can predict the occurrence of POD to a certain extent. In addition, early identification of patients at risk of malnutrition and appropriate surgical planning can reduce the incidence of POD.
术前虚弱是与术后谵妄（POD）相关的危险因素，已引起临床医生更多关注，但尚无研究表明其与老年开颅手术患者相关。因此，本研究旨在确定术前虚弱对老年患者，尤其是接受开颅手术患者的POD的影响。
收集2022年10月至2023年5月接受择期开颅手术的老年患者。术前一天使用FRAIL量表评估虚弱的发生情况。术后三天内使用意识模糊评估法（CAM）评估POD的发生情况。将参与者分为两组，一组为POD组，采用逻辑回归分析寻找POD的风险变量，并通过受试者操作特征曲线确定术前虚弱对POD的预测价值。
本研究共纳入300例患者，其中83例（27.7%）表现出术前虚弱，69例（23.0%）发生POD。多因素逻辑回归分析结果表明，术前虚弱（OR：8.816，95%CI：3.972-19.572）、术前低白蛋白血症（OR：0.893，95%CI：0.811-0.984）、低体重指数（OR：0.793，95%CI：0.698-0.901）和手术时间延长（OR：1.007，95%CI：1.004-1.010）是接受开颅手术的老年患者发生POD的独立危险因素。我们使用这些因素构建了一个风险预测模型，其ROC曲线下面积为0.908（95%CI：0.869-0.947，P < 0.001）。术前虚弱使预测模型的判别能力提高了0.037。POD与更长的住院时间和更高的住院费用相关。
术前虚弱是接受择期开颅手术的老年患者发生POD的独立危险因素，且在一定程度上可预测POD的发生。此外，早期识别有营养不良风险的患者并进行适当的手术规划可降低POD的发生率。
