Trajectory of Functional Recovery After Postoperative Delirium in Elective Surgery.
Trajectory of Functional Recovery After Postoperative Delirium in Elective Surgery.
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DOI：
10.1097/sla.0000000000001952
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发表时间：
2017-04
影响因子：
9
通讯作者：
SAGES Study Group
中科院分区：
文献类型：
--
作者：
Hshieh TT;Saczynski J;Gou RY;Marcantonio E;Jones RN;Schmitt E;Cooper Z;Ayres D;Wright J;Travison TG;Inouye SK;SAGES Study Group
描述选择性手术后的功能恢复，并确定是否改善不同的个人发展谵妄。目前还没有针对老年人的大型研究调查谵妄是否会影响择期手术后的功能恢复轨迹。这项前瞻性观察性研究评估了566名年龄在70岁及以上的个体之间的这种关联。在住院期间，使用意识模糊评估方法（CAM）每天评估接受重大择期手术的患者是否存在谵妄和谵妄的严重程度，并随访其功能恢复18个月。在术前和术后1、2、6、12和18个月时获得日常生活活动（ADL）和工具性日常生活活动（IADL）量表以及SF-12的身体成分总结。然后使用混合效应回归分析从这些量表得出的复合指数[标准差10，最小临床显著差异（MCID）2]。平均年龄为77岁; 58%的参与者为女性，24%的参与者术后出现谵妄。谵妄的参与者表现出比没有谵妄的参与者更少的功能恢复;在一个月时，功能复合指标的协变量调整平均差异为-1.5（95%置信区间，CI：-3.3，-0.2）。从2个月到18个月，相应的差异为-1.8（-3.2，-0.3），与MCID相当。谵妄与18个月内功能恢复的持续性和临床意义的损害相关。对谵妄高危患者进行多因素预防性干预和定制的过渡期护理计划可能有助于使择期手术的功能获益最大化。在一组566例接受择期手术的老年患者中，谵妄与功能恢复受损相关，术后持续18个月。对谵妄高危患者进行多因素预防性干预和定制的过渡期护理计划可能有助于使择期手术的功能获益最大化。
To describe functional recovery following elective surgery and to determine whether improvements differ among individuals who develop delirium. No large studies of older adults have investigated whether delirium influences the trajectory of functional recovery following elective surgery. This prospective observational study assessed this association among 566 individuals age 70 years and older. Patients undergoing major elective surgery were assessed daily while in-hospital for presence and severity of delirium using the confusion assessment method (CAM), and their functional recovery was followed for 18 months thereafter. The Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) Scales and the Physical Component Summary of the SF-12 were obtained pre-surgery and at 1, 2, 6, 12 and 18 months. A composite index [standard deviation 10, minimally clinically significant difference (MCID) 2] derived from these scales was then analyzed using mixed effects regression. Mean age was 77 years; 58% of participants were women and 24% developed post-operative delirium. Participants with delirium demonstrated lesser functional recovery than their counterparts without delirium; at one month the covariate-adjusted mean difference on the functional composite was −1.5 (95% confidence interval, CI: −3.3, −0.2). From two to 18 months the corresponding difference was −1.8 (−3.2, −0.3), an effect comparable to the MCID. Delirium was associated with persistent and clinically meaningful impairment of functional recovery, to 18 months. Use of multifactorial preventive interventions for patients at high risk for delirium and tailored transitional care planning may help to maximize the functional benefits of elective surgery. In a cohort of 566 older patients undergoing elective surgery, delirium was associated with impaired functional recovery, which persisted for 18 months post-surgery. Use of multifactorial preventive interventions for patients at high risk for delirium and tailored transitional care planning may help to maximize the functional benefits of elective surgery.