Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients.
Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients.
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DOI：
10.1371/journal.pone.0136071
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
van der Laan L
中科院分区：
文献类型：
--
作者：
Raats JW;van Eijsden WA;Crolla RM;Steyerberg EW;van der Laan L
早期识别有谵妄风险的患者是重要的，因为适当的及时干预可以预防谵妄和相关有害结果的发生。本研究的目的是评估谵妄的预后因素，包括描述虚弱的因素，在接受大手术的老年患者。我们纳入了2013年3月至2014年11月接受择期手术的65岁及以上患者。患者因腹主动脉瘤（AAA）或结直肠癌接受手术。使用谵妄观察筛选量表对谵妄进行前瞻性评分。采用回归分析法对谵妄的术前和围手术期预测因素进行分析。谵妄后的结局包括不良事件、住院时间、出院目的地和死亡率。共纳入232例患者。51例（22%）因AAA接受手术，181例（78%）因结直肠癌接受手术。术后发生谵妄35例（15%）。术后谵妄的预测因素包括：病史中的谵妄（比值比12 [95%置信区间2.7-50]）、年龄增长（比值比2.0 [95%置信区间1.1-3.8]）/10年和ASA评分≥3（比值比2.6 [95%置信区间1.1-5.9]）。谵妄的发生与不良事件、住院时间和死亡率的增加有关。术后谵妄是老年患者大手术后常见的并发症，与不良事件、住院时间和死亡率的增加有关。病史中的谵妄、高龄和ASA评分可能有助于确定谵妄风险增加的患者。在接受大手术的老年患者中，进一步注意预防谵妄是必不可少的。
Early identification of patients at risk for delirium is important, since adequate well timed interventions could prevent occurrence of delirium and related detrimental outcomes. The aim of this study is to evaluate prognostic factors for delirium, including factors describing frailty, in elderly patients undergoing major surgery. We included patients of 65 years and older, who underwent elective surgery from March 2013 to November 2014. Patients had surgery for Abdominal Aortic Aneurysm (AAA) or colorectal cancer. Delirium was scored prospectively using the Delirium Observation Screening Scale. Pre- and peri-operative predictors of delirium were analyzed using regression analysis. Outcomes after delirium included adverse events, length of hospital stay, discharge destination and mortality. We included 232 patients. 51 (22%) underwent surgery for AAA and 181 (78%) for colorectal cancer. Postoperative delirium occurred in 35 patients (15%). Predictors of postoperative delirium included: delirium in medical history (Odds Ratio 12 [95% Confidence Interval 2.7–50]), advancing age (Odds Ratio 2.0 [95% Confidence Interval 1.1–3.8]) per 10 years, and ASA-score ≥3 (Odds Ratio 2.6 [95% Confidence Interval 1.1–5.9]). Occurrence of delirium was related to an increase in adverse events, length of hospital stay and mortality. Postoperative delirium is a frequent complication after major surgery in elderly patients and is related to an increase in adverse events, length of hospital stay, and mortality. A delirium in the medical history, advanced age, and ASA-score may assist in defining patients at increased risk for delirium. Further attention to prevention of delirium is essential in elderly patients undergoing major surgery.