Chen Xuming, Yao Wei, Liu Xiaoyang, Xie Qiyu, Wang Duan, Xu Hong, Zhou Zongke
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Department of Orthopedics, Lhasa People's Hospital, Lhasa, China.
Front Med (Lausanne). 2025 Jul 16;12:1626383. doi: 10.3389/fmed.2025.1626383. eCollection 2025.
This study aims to investigate the association between the preoperative geriatric nutritional risk index (GNRI) and postoperative delirium (POD) in patients undergoing hip or knee revision arthroplasty.
820 patients who underwent hip or knee revision arthroplasty from January 2014 to September 2024 were included. The exposure variable was preoperative GNRI, and the outcome variable was POD, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria using the Confusion Assessment Method (CAM). The study considered covariates such as age, sex, body mass index, albumin, and comorbidities, employing multivariate logistic regression analysis to explore the association between preoperative GNRI and POD.
Among 820 patients, 76 (9.27%) developed POD within 7 days postoperatively. Patients with POD had a significantly lower GNRI (97.53 ± 9.54) compared to those without POD (101.05 ± 8.85, = 0.003). For each 1-unit increase in GNRI, the risk of POD decreased by 4% (OR = 0.96, 95% CI: 0.94-0.99, = 0.011). Quartile analysis showed that patients in the highest GNRI quartile had a significantly lower POD incidence compared to those in the lowest quartile (OR = 0.43, 95% CI: 0.20-0.92, p for trend = 0.037). A protective threshold of GNRI was identified at 101.96.
A significant association was observed between preoperative GNRI and POD in patients undergoing hip or knee revision arthroplasty. However, due to the retrospective single-center design and potential unmeasured confounding, further multicenter prospective studies are warranted to validate these findings and explore underlying mechanisms.
本研究旨在调查接受髋关节或膝关节翻修置换术患者的术前老年营养风险指数（GNRI）与术后谵妄（POD）之间的关联。
纳入2014年1月至2024年9月期间接受髋关节或膝关节翻修置换术的820例患者。暴露变量为术前GNRI，结局变量为POD，根据《精神疾病诊断与统计手册》（DSM-5）标准，采用意识错乱评估法（CAM）进行诊断。该研究考虑了年龄、性别、体重指数、白蛋白和合并症等协变量，采用多因素逻辑回归分析来探讨术前GNRI与POD之间的关联。
在820例患者中，76例（9.27%）在术后7天内发生POD。发生POD的患者GNRI显著低于未发生POD的患者（97.53±9.54 vs 101.05±8.85，P = 0.003）。GNRI每增加1个单位，POD风险降低4%（OR = 0.96，95%CI：0.94 - 0.99，P = 0.011）。四分位数分析显示，GNRI最高四分位数的患者POD发生率显著低于最低四分位数的患者（OR = 0.43，95%CI：0.20 - 0.92，趋势P = 0.037）。确定GNRI的保护阈值为101.96。
在接受髋关节或膝关节翻修置换术的患者中，观察到术前GNRI与POD之间存在显著关联。然而，由于本研究为回顾性单中心设计且存在潜在的未测量混杂因素，因此有必要开展进一步的多中心前瞻性研究来验证这些发现并探索潜在机制。
