术前认知筛查可预测老年患者外科矫形术后并发症
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Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients.
背景与目的
美国外科医师学院和美国老年病学会建议术前对老年手术患者进行认知筛查。我们假设无痴呆病史患者的未被发现的认知损害是发生术后并发症的危险因素。
方 法
本研究纳入了211名择期行髋关节或膝关节置换的患者（≥65岁，无痴呆诊断）。患者术前使用Mini-Cog量表进行认知筛查，使用标准仪器或医疗记录收集医疗、功能、情感/社会和人口学数据。结局包括安排到家以外的地方疗养（主要结局）、谵妄、住院医疗并发症、住院时间、30天急诊就诊和死亡率。进行单变量和多变量数据分析。
结 果
筛查发现50/211名（24％）患者可能存在认知功能障碍（Mini-Cog ≤2）。调整年龄后多变量分析，与Mini-Cog评分＞2的患者相比，Mini-Cog评分≤2的患者更可能被安排到家以外的地方疗养（67％vs 34％;比值比= 3.88，95％CI=1.58-9.55）、发生术后谵妄（21％vs7％; 比值比= 4.52，95％CI = 1.30-15.68）、住院时间延长（风险比= 0.63，95％CI = 0.42-0.95）。
结 论
许多行择期矫形手术的老年患者术前可能存在认知损害，这种损害可导致术后谵妄的发生和住院时间延长，并降低出院后回家疗养的可能。
原始文献摘要
Culley DJ, Flaherty D, Fahey MC, et al. Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients[J]. Anesthesiology，2017, doi: 10.1097/ALN.0000000000001859. [Epub ahead of print]
Abstract
BACKGROUND:
The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications.
METHODS:
We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement. Patients were cognitively screened preoperatively using the Mini-Cog and demographic, medical, functional, and emotional/social data were gathered using standard instruments or review of the medical record. Outcomes included discharge to place other than home (primary outcome), delirium, in-hospital medical complications, hospital length-of-stay, 30-day emergency room visits, and mortality. Data were analyzed using univariate and multivariate analyses.
RESULTS:
Fifty of 211 (24%) patients screened positive for probable cognitive impairment (Mini-Cog less than or equal to 2). On age-adjusted multivariate analysis, patients with a Mini-Cog score less than or equal to 2 were more likely to be discharged to a place other than home (67% vs. 34%; odds ratio = 3.88, 95% CI = 1.58 to 9.55), develop postoperative delirium (21% vs. 7%; odds ratio = 4.52, 95% CI = 1.30 to 15.68), and have a longer hospital length of stay (hazard ratio = 0.63, 95% CI = 0.42 to 0.95) compared to those with a Mini-Cog score greater than 2.
CONCLUSIONS:
Many older elective orthopedic surgical patients have probable cognitive impairment preoperatively. Such impairment is associated with development of delirium postoperatively, a longer hospital stay, and lower likelihood of going home upon hospital discharge.
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