Gaps in cognitive care among older patients undergoing spine surgery.
Gaps in cognitive care among older patients undergoing spine surgery.
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接受脊柱手术的老年患者认知护理方面存在差距。
DOI：
10.1111/jgs.18843
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发表时间：
2024
影响因子：
6.3
通讯作者：
Possin,KatherineL
中科院分区：
文献类型：
--
作者：
BarretoChang,OdmaraL;Pawar,Niti;Whitlock,ElizabethL;Miller,Bruce;Possin,KatherineL
前言在接受手术的老年人中，术后妄想是最常见的并发症。认知障碍和痴呆症是术后精神错乱的主要危险因素，但它们往往被忽视。众所周知，对高危人群进行预防干预可以将精神错乱的可能性降低高达40%。这项研究的目的是评估由于基线认知障碍而有精神障碍风险的患者缺少预防干预的频率。方法我们使用老年观察性研究围术期麻醉神经认知障碍评估(PANDA-G)的数据和加州大学旧金山分校的临床数据进行了一项回顾性研究。年龄在65岁以上的患者在接受单一主要学术机构的住院脊柱手术之前，作为研究方案的一部分，接受了术前多领域认知评估。临床团队无法获得认知测试的结果。使用电子病历，我们评估在基线时认知受损的患者是否接受了防止精神错乱的命令、睡眠命令以及避免服用AGS Beers Criteria®潜在的不适当药物。结果在纳入研究的245名患者中，42%是女性。平均[SD]年龄为72[5.2]岁。40%的受试者在术前认知功能受损(N= 98)，其中34%的受试者术后出现精神错乱。在术前认知障碍的患者中，45%的患者没有接受精神分裂症的预防命令，43%的患者接受了PIM，49%的患者缺少睡眠命令。在70%的患者中，至少遗漏了三种预防措施中的一种。讨论在接受脊柱手术的老年人中，未诊断的术前认知障碍是常见的。当临床医生无法获得认知测试结果时，有基线认知障碍的患者通常没有接受循证的妄想预防干预。这些发现突出了通过术前认知评估和临床沟通改善围手术期脑健康护理的机会。
IntroductionAmong older adults undergoing surgery, postoperative delirium is the most common complication. Cognitive impairment and dementia are major risk factors for postoperative delirium, yet they are frequently under‐recognized. It is well established that applying delirium preventive interventions to at‐risk individuals can reduce the likelihood of delirium by up to 40%. The aim of this study was to evaluate how often delirium preventive interventions are missing in patients at risk for delirium due to baseline cognitive impairment.MethodsWe conducted a retrospective study using data from the observational study Perioperative Anesthesia Neurocognitive Disorder Assessment‐Geriatric (PANDA‐G) and clinical data from the University of California San Francisco delirium prevention bundle. Patients age 65+ received preoperative multidomain cognitive assessment as part of a research protocol prior to undergoing inpatient spine surgery at a single major academic institution. Results of the cognitive testing were not available to clinical teams. Using electronic medical records, we evaluated if patients who were cognitively impaired at baseline received delirium prevention orders, sleep orders, and avoidance of AGS Beers Criteria® potentially inappropriate medications.ResultsOf the 245 patients included in the study, 42% were women. The mean [SD] age was 72 [5.2] years. Preoperative cognitive impairment was identified in 40% of participants (N= 98), and of these, 34% had postoperative delirium. Of patients with preoperative cognitive impairment, 45% did not receive delirium preventive orders, 43% received PIMs, and 49% were missing sleep orders. At least one of the three delirium preventive interventions was missing in 70% of the patients.DiscussionUndiagnosed preoperative cognitive impairment among older adults undergoing spine surgery is common. When cognitive test results were not available to clinicians, patients with baseline cognitive impairment frequently did not receive evidence‐based delirium preventive interventions. These findings highlight an opportunity to improve perioperative brain health care via preoperative cognitive assessment and clinical communication.