【罂粟摘要】 老年患者髋关节手术后术前谵妄与术后结局的关系
老年患者髋关节手术后术前谵妄与术后结局的关系
探讨老年患者髋关节手术后患者术前谵妄与术后结局的关系。
回顾性队列研究。
术后恢复室。
8466名年龄65岁或以上，接受股骨骨折手术复位的患者。在所有被研究的总人群中，1075人有术前谵妄。术前谵妄患者中，ASA 3级及以下患者746例，ASA 4级及以上患者327例。7391例无术前谵妄的患者中，ASA 3级及以下患者5773例，ASA 4级及以上患者1605例。各组其余患者ASA分级未知。
我们采用多变量logistic回归分析来探讨术前谵妄与术后30天预后的关系。并报告每个协变量的优势比（OR）和相关的95%可信区间（CI）。
收集有关术后结果发生率的数据，包括：谵妄、肺部并发症、住院时间延长、感染、肾脏并发症、血管并发症、心脏并发症、需要输血、再入院和死亡率。
调整了潜在的混杂因素后，与无术前谵妄的患者比较，有术前谵妄的患者术后谵妄的几率（OR 9.38，95%CI 7.94-11.14）、肺部并发症（OR 1.83，95%CI 1.4-2.36）、住院时间延长（OR 1.47，95%CI 1.26-1.72）、再入院（OR 1.27，95%CI 1.01-1.59）和死亡率（OR 1.92，95%CI 1.54-2.39）的发生率都显著增高。
在控制了潜在的混杂变量后，我们发现术前谵妄与术后谵妄、肺部并发症、住院时间延长、再次入院和死亡率有关。由于缺乏对术前谵妄及其术后结果的研究，我们的数据为进一步调查以及制定和实施有针对性的降低风险方案提供了一个强有力的起点。
The association of preoperative delirium with postoperative outcomes following hip surgery in the elderly
Study objective: To determine the association of preoperative delirium with postoperative outcomes following hip surgery in the elderly.
Design: Retrospective cohort study.
Setting: Postoperative recovery.
Patients: 8466 patients all of whom were 65 years of age or older undergoing surgical repair of a femoral fracture. Of the total population studied, 1075 had preoperative delirium. Of those with preoperative delirium, 746 were ASA class 3 or below and 327 were ASA class 4 or above. Of the 7391 patients without preoperative delirium, 5773 were ASA class 3 or below and 1605 were ASA class 4 or above. The remainder in each group was of unknown ASA class.
Interventions: We used multivariable logistic regression to explore the association of preoperative delirium with 30-day postoperative outcomes. The odds ratio (OR) with associated 95% confidence interval (CI) was reported for each covariate.
Measurements: Data was collected regarding the incidence of postoperative outcomes including: delirium, pulmonary complications, extended hospital stay, infection, renal complications, vascular complications, cardiac complications, transfusion necessity, readmission, and mortality.
Main Results: After adjusting for potential confounders, the odds of postoperative delirium (OR 9.38, 95% CI 7.94–11.14), pulmonary complications (OR 1.83, 95% CI 1.4–2.36), extended hospital stay (OR 1.47, 95% CI 1.26–1.72), readmission (OR 1.27, 95% CI 1.01–1.59) and mortality (OR 1.92, 95% CI 1.54–2.39) were all significantly higher in patients with preoperative delirium compared to those without.
Conclusions: After controlling for potential confounding variables, we showed that preoperative delirium was associated with postoperative delirium, pulmonary complications, extended hospital stay, hospital readmission, and mortality. Given the lack of studies on preoperative delirium and its postoperative outcomes, our data provides a strong starting point for further investigations as well as the development and implementation of targeted risk-reduction programs.
翻译：冯玉蓉 编辑：佟睿 审校：曹莹
贵州医科大学 高鸿教授课题组