Joo Hyundeok, Avelino-Silva Thiago J, Diaz-Ramirez L Grisell, Lee Sei J, Whitlock Elizabeth L
Department of Anesthesia & Perioperative Care, University of California, San Francisco, California, USA.
Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA.
J Am Geriatr Soc. 2025 Mar;73(3):867-873. doi: 10.1111/jgs.19247. Epub 2024 Nov 5.
Older adults often require surgical care and are at elevated risk of delirium. We explored delirium risk profiles across the population of U.S. older adults who underwent one of 10 common noncardiac surgeries.
We analyzed Health and Retirement Study (HRS) participants linked with Medicare billing data who underwent the following 10 noncardiac surgeries from 2000 to 2018 at age 65 or more: total knee arthroplasty (TKA), total hip arthroplasty (THA), spine surgery, cholecystectomy, colorectal surgery, hernia repair (ventral, umbilical, or incisional), endarterectomy, prostatectomy, transurethral resection of the prostate (TURP), and hysterectomy. Demographic and health covariates were obtained from the HRS dataset. Latent cognitive ability was calculated from cognitive testing, proxy reports, and demographics at the preoperative HRS interview. We compared standardized differences for delirium risk factors across the 10 surgeries and qualitatively clustered them into phenotypical subgroups.
We analyzed 7424 older adults (mean age 76 ± 6 years, 45% male). Endarterectomy patients presented with the highest burden of nearly all health and cognitive factors, implying higher delirium risk (e.g., stroke, 22%; depressive symptoms, 30%; high school or less education, 73%; frailty, 42%; lowest latent cognitive ability). A second "general surgery" phenotype, including cholecystectomy, colorectal, and hernia surgery patients, experienced more frailty (29%-32%) and depressive symptoms (24%-26%), with moderate comorbidity burden. A third "pain" phenotype, which included TKA, THA, and spine surgery patients, commonly reported moderate or severe pain (47%-53%) and impairment in activities of daily living (ADL, 23%-30%), but fewer comorbid medical conditions. The remaining surgery types (hysterectomy, prostatectomy, TURP) were not phenotypically grouped and generally had lower risk features for delirium.
In an epidemiological cohort of US older adults, we identified clinically meaningful heterogeneity in delirium risk profiles across different surgical types, which may have implications for delirium risk stratification and delirium prevention or treatment.
老年人常常需要外科手术治疗，且发生谵妄的风险较高。我们探讨了接受10种常见非心脏手术之一的美国老年人群的谵妄风险特征。
我们分析了与医疗保险计费数据相关联的健康与退休研究（HRS）参与者，这些参与者在2000年至2018年期间65岁及以上接受了以下10种非心脏手术：全膝关节置换术（TKA）、全髋关节置换术（THA）、脊柱手术、胆囊切除术、结直肠手术、疝修补术（腹疝、脐疝或切口疝）、动脉内膜切除术、前列腺切除术、经尿道前列腺切除术（TURP）和子宫切除术。人口统计学和健康协变量来自HRS数据集。潜在认知能力通过术前HRS访谈中的认知测试、代理报告和人口统计学数据计算得出。我们比较了10种手术中谵妄风险因素的标准化差异，并将它们定性地聚类为表型亚组。
我们分析了7424名老年人（平均年龄76±6岁，45%为男性）。动脉内膜切除术患者几乎在所有健康和认知因素方面负担最重，这意味着谵妄风险更高（例如，中风，22%；抑郁症状，30%；高中及以下学历，73%；虚弱，42%；潜在认知能力最低）。第二种“普通外科手术”表型，包括胆囊切除术、结直肠手术和疝手术患者，虚弱程度更高（29%-32%）且抑郁症状更多（24%-26%），合并症负担中等。第三种“疼痛”表型，包括TKA、THA和脊柱手术患者，通常报告中度或重度疼痛（47%-53%）以及日常生活活动（ADL）受损（23%-30%），但合并的内科疾病较少。其余手术类型（子宫切除术、前列腺切除术、TURP）未进行表型分组，且谵妄风险特征一般较低。
在美国老年人群的一项流行病学队列研究中，我们发现不同手术类型的谵妄风险特征存在具有临床意义的异质性，这可能对谵妄风险分层以及谵妄的预防或治疗具有启示意义。
