Perioperative risk factors for recovery room delirium after elective non-cardiovascular surgery under general anaesthesia.
Perioperative risk factors for recovery room delirium after elective non-cardiovascular surgery under general anaesthesia.
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全麻择期非心血管手术后苏醒室谵妄的围手术期危险因素
DOI：
10.1186/s13741-020-00174-0
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发表时间：
2021-02-03
期刊：
影响因子：
--
通讯作者：
Mei W
中科院分区：
文献类型：
--
作者：
Wu J;Gao S;Zhang S;Yu Y;Liu S;Zhang Z;Mei W
虽然术后谵妄是一种常见的手术并发症，但对麻醉后监护室（PACU）发生谵妄的危险因素知之甚少。本研究旨在确定择期非心血管手术患者发生恢复室谵妄（RRD）的术前和术中风险因素。根据重症监护室（CAM-ICU）的混乱评估方法诊断RRD。我们收集了228例在全身麻醉下接受择期非心血管手术的患者的围手术期数据，并进行了单变量和多变量logistic回归分析，以确定与RRD相关的风险因素。记录PACU和术后事件，以评估RRD的结局。57例患者（25%）出现RRD。吸入麻醉药维持麻醉的多因素分析（OR = 6.294，95% CI 1.4-28.8，校正p = 0.03），恶性原发病（OR = 3.464，95% CI = 1.396-8.592，校正p = 0.018），美国麻醉医师协会身体状况（ASA-PS）III-V（OR = 3.389，95% CI = 1.401-8.201，校正p = 0.018），血清总胆红素或直接胆红素升高（OR = 2.535，95% CI = 1.006-6.388，校正p = 0.049）和侵入性手术（OR = 2.431，95% CI = 1.103-5.357，校正p = 0.035）被确定为RRD的独立风险因素。RRD与较高的医疗费用相关（31，428元[17，872 - 43，674] vs 16，555元[12，618 - 27，788]，校正后p = 0.002），中位住院时间较长（17天[12-23.5] vs 11天[9-17]，校正后p = 0.002）和更长的术后住院时间（11天[7-15] vs 7天[5-10]，校正后p = 0.002）。术前识别RRD的高风险患者将能够形成更及时的术后谵妄管理方案。
Although postoperative delirium is a frequent complication of surgery, little is known about risk factors for delirium occurring in the post-anaesthesia care unit (PACU). The aim of this study was to determine pre- and intraoperative risk factors for the development of recovery room delirium (RRD) in patients undergoing elective non-cardiovascular surgery. RRD was diagnosed according to the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We collected perioperative data in 228 patients undergoing elective non-cardiovascular surgery under general anaesthesia and performed univariate and multivariate logistic regression to identify risk factors related to RRD. PACU and postoperative events were recorded to assess the outcome of RRD. Fifty-seven patients (25%) developed RRD. On multivariate analysis, maintenance of anaesthesia with inhalation anaesthetic agents (OR = 6.294, 95% CI 1.4–28.8, corrected p = 0.03), malignant primary disease (OR = 3.464, 95% CI = 1.396–8.592, corrected p = 0.018), American Society of Anaesthesiologists Physical Status (ASA-PS) III–V (OR = 3.389, 95% CI = 1.401–8.201, corrected p = 0.018), elevated serum total or direct bilirubin (OR = 2.535, 95% CI = 1.006–6.388, corrected p = 0.049), and invasive surgery (OR = 2.431, 95% CI = 1.103–5.357, corrected p = 0.035) were identified as independent risk factors for RRD. RRD was associated with higher healthcare costs (31,428 yuan [17,872–43,674] versus 16,555 yuan [12,618–27,788], corrected p = 0.002), a longer median hospital stay (17 days [12–23.5] versus 11 days [9–17], corrected p = 0.002), and a longer postoperative stay (11 days [7–15] versus 7 days [5–10], corrected p = 0.002]). Identifying patients at high odds for RRD preoperatively would enable the formation of more timely postoperative delirium management programmes.
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影响因子：
158.5
作者：
Inouye, SK;Bogardus, ST;Cooney, LW
通讯作者：
Cooney, LW
影响因子：
8.8
作者：
Ely, EW;Margolin, R;Inouye, SK
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Inouye, SK
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120.7
作者：
FRANCIS, J;MARTIN, D;KAPOOR, WN
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6.2
作者：
Han, Jin H.;Shintani, Ayumi;Eden, Svetlana;Morandi, Alessandro;Solberg, Laurence M.;Schnelle, John;Dittus, Robert S.;Storrow, Alan B.;Ely, E. Wesley
通讯作者：
Ely, E. Wesley
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8.8
作者：
Aono, J;Ueda, W;Manabe, M
通讯作者：
Manabe, M