Interrelationship of postoperative delirium and cognitive impairment and their impact on the functional status in older patients undergoing orthopaedic surgery: a prospective cohort study.
Interrelationship of postoperative delirium and cognitive impairment and their impact on the functional status in older patients undergoing orthopaedic surgery: a prospective cohort study.
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DOI：
10.1371/journal.pone.0110339
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Chen LK
中科院分区：
文献类型：
--
作者：
Liang CK;Chu CL;Chou MY;Lin YT;Lu T;Hsu CJ;Chen LK
术后谵妄对老年患者出院后功能状态的影响尚不清楚，关于认知功能障碍和术后谵妄之间的相互关系知之甚少。因此，主要目的是评价接受骨科手术后发生谵妄的患者的出院后功能状态以及术后谵妄与潜在认知障碍的相互关系。这项前瞻性队列研究于2011年4月至2012年3月在三级医疗中心进行，招募了所有年龄超过60岁的骨科手术受试者。收集基线特征（年龄、性别、BMI和居住安排）、手术相关因素（阿萨分级、入院类型、手术类型和住院时间）、老年评估结果（术后谵妄、认知、抑郁情绪、合并症、疼痛、营养不良、多种药物、ADL和工具性[I]ADL）以及术后1-12个月ADL和IADL功能状态进行分析。总体而言，232名患者中有9.1%（平均年龄：74.7±7.8岁）出现术后谵妄，这与术后6个月和12个月的IADL下降显着相关（RR：6.22，95%CI：1.08-35.70和RR：12.54，95%CI：1.88-83.71）。谵妄叠加认知障碍是术后6个月和12个月功能状态差的重要预测因素（第6个月ADL RR：12.80，95% CI：1.65-99.40，第12个月RR：7.96，95% CI：1.35-46.99; RR：13.68，95% CI：6个月时IADL为1.94-96.55，12个月时RR为30.61，95%CI为2.94-318.54）。在接受骨科手术的老年患者中，术后谵妄可预测IADL下降，谵妄叠加认知障碍是ADL和IADL功能状态恶化的独立危险因素。需要早期识别认知功能并预防谵妄，以改善骨科手术后的功能状态。
The impact of postoperative delirium on post-discharge functional status of older patients remains unclear, and little is known regarding the interrelationship between cognitive impairment and post-operative delirium. Therefore, the main purpose was to evaluate the post-discharge functional status of patients who experience delirium after undergoing orthopaedic surgery and the interrelationship of postoperative delirium with underlying cognitive impairment. This prospective cohort study, conducted at a tertiary care medical center from April 2011 to March 2012, enrolled all subjects aged over 60 years who were admitted for orthopaedic surgery. The baseline characteristics (age, gender, BMI, and living arrangement), surgery-related factors (ASA class, admission type, type of surgery, and length of hospital stay), results of geriatric assessment (postoperative delirium, cognition, depressive mood, comorbidity, pain, malnutrition, polypharmacy, ADL, and instrumental [I]ADL) and 1–12-month postoperative ADL and IADL functional status were collected for analysis. Overall, 9.1% of 232 patients (mean age: 74.7±7.8 years) experienced postoperative delirium, which was significantly associated with IADL decline at only 6 and 12 months postoperatively (RR: 6.22, 95% CI: 1.08–35.70 and RR: 12.54, 95% CI: 1.88–83.71, respectively). Delirium superimposed on cognitive impairment was a significant predictor for poor functional status at 6 and 12 months postoperatively (RR: 12.80, 95% CI: 1.65–99.40 for ADL at the 6th month, and RR: 7.96, 95% CI: 1.35–46.99 at the 12th month; RR: 13.68, 95% CI: 1.94–96.55 for IADL at the 6th month, and RR: 30.61, 95% CI: 2.94–318.54 at the 12th month, respectively). Postoperative delirium is predictive of IADL decline in older patients undergoing orthopaedic surgery, and delirium superimposed on cognitive impairment is an independent risk factor for deterioration of ADL and IADL functional status. Early identification of cognitive function and to prevent delirium are needed to improve functional status following orthopaedic surgery.
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影响因子：
11.2
作者：
Gottesman, Rebecca F.;Grega, Maura A.;Bailey, Maryanne M.;Pham, Luu D.;Zeger, Scott L.;Baumgartner, William A.;Selnes, Ola A.;McKhann, Guy M.
通讯作者：
McKhann, Guy M.
影响因子：
158.5
作者：
Inouye, SK;Bogardus, ST;Cooney, LW
通讯作者：
Cooney, LW
影响因子：
5.7
作者：
Inouye, SK;Rushing, JT;Pompei, P
通讯作者：
Pompei, P
影响因子：
2.6
作者：
Fick, Donna M.;Steis, Melinda R.;Waller, Jennifer L.;Inouye, Sharon K.
通讯作者：
Inouye, Sharon K.
DOI：
10.1111/j.1532-5415.1992.tb02111.x
发表时间：
1992-06-01
影响因子：
6.3
作者：
FRANCIS, J;KAPOOR, WN
通讯作者：
KAPOOR, WN