Does preoperative risk for delirium moderate the effects of postoperative pain and opiate use on postoperative delirium?
Does preoperative risk for delirium moderate the effects of postoperative pain and opiate use on postoperative delirium?
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DOI：
10.1016/j.jagp.2013.01.069
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发表时间：
2013-10
影响因子：
7.2
通讯作者：
Kinjo, Sakura
中科院分区：
文献类型：
--
作者：
Leung, Jacqueline M.;Sands, Laura P.;Lim, Eunjung;Tsai, Tiffany L.;Kinjo, Sakura
研究术前谵妄风险是否会调节术后疼痛和阿片类药物对术后谵妄发生的影响。前瞻性队列研究大学医学中心计划进行重大非心脏手术的≥ 65岁患者术前和术后进行结构化访谈，以确定是否存在谵妄，使用混乱评估方法进行定义。我们首先开发了一个预测模型，根据术前患者数据确定哪些患者发生谵妄的风险高与低。然后，我们计算了一个逻辑回归模型，以确定术前谵妄的风险是否缓和术后疼痛和阿片类药物对事件谵妄的影响。在581例患者中，40%在术后第1天或第2天发生谵妄。术后谵妄的独立术前预测因素包括认知功能低下、中枢神经系统疾病史、高手术风险和大型脊柱和关节成形术。与术前发生谵妄的低风险患者相比，术前高风险组患者术后发生谵妄的相对风险为2.38（95%CI = 1.67-3.40）。一个显着的三向相互作用表明，术前谵妄的风险显着缓和术后疼痛和阿片类药物的使用对谵妄的发展的影响。在术前发生谵妄的高风险患者中，术后疼痛高且接受高阿片类药物剂量的患者中，谵妄的发生率为72%，而术前风险低、术后疼痛低且接受低阿片类药物剂量的患者中，谵妄的发生率为20%。高水平的术后疼痛和使用高剂量阿片类药物增加了所有患者术后谵妄的风险。然而，谵妄的发生率最高的是术前谵妄风险高、术后疼痛高和使用高剂量阿片类药物的患者。
To investigate whether preoperative risk for delirium moderates the effect of postoperative pain and opioids on the development of postoperative delirium. Prospective cohort study University medical center Patients ≥ 65 years of age scheduled for major noncardiac surgery A structured interview was conducted pre- and post-operatively to determine the presence of delirium, defined using the Confusion Assessment Method. We first developed a prediction model to determine which patients were at high vs. low risk for the development of delirium based on preoperative patient data. We then computed a logistic regression model to determine whether preoperative risk for delirium moderates the effect of postoperative pain and opioids on incident delirium. Of 581 patients, 40% developed delirium on days 1 or 2 after surgery. Independent preoperative predictors of postoperative delirium included lower cognitive status, a history of central nervous system disease, high surgical risk, and major spine and joint arthroplasty surgery. Compared to the patients at low preoperative risk for developing delirium, the relative risk for postoperative delirium for those in the high preoperative risk group was 2.38 (95% CI = 1.67–3.40). A significant three-way interaction indicates that preoperative risk for delirium significantly moderated the effect of postoperative pain and opioid use on the development of delirium. Among patients at high preoperative risk for development of delirium who also had high postoperative pain and received high opioid doses, the incidence of delirium was 72%, compared to 20% among patients with low preoperative risk, low postoperative pain and received low opioid doses. High levels of postoperative pain and using high opioid doses increased risk for postoperative delirium for all patients. However, the highest incidence of delirium was among patients who had high preoperative risk for delirium and also had high postoperative pain and used high opioid doses.
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通讯作者：
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