Incidence of postoperative delirium in elderly ambulatory patients: A prospective evaluation using the FAM-CAM instrument
Incidence of postoperative delirium in elderly ambulatory patients: A prospective evaluation using the FAM-CAM instrument
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DOI：
10.1016/j.jclinane.2018.09.034
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发表时间：
2019-03-01
影响因子：
6.7
通讯作者：
Cuvillon, Philippe
中科院分区：
文献类型：
--
作者：
Aya, Antoine G. M.;Pouchain, Pierre-Henri;Cuvillon, Philippe
背景资料：老年住院患者术后谵妄的发生率较高，但对门诊手术患者的了解甚少。目的：确定老年患者出院后谵妄的发生率。设计：前瞻性观察研究。患者：老年患者干预措施：填写家庭困惑评估方法（FAM-CAM）问卷在两个不同的场合对家庭护理人员进行电话采访时（11个项目）：手术前5 - 3天和手术后3 - 5天。主要结果测量：检测急性发作和波动过程中注意力不集中，思维混乱，意识水平改变，定向障碍，知觉障碍和精神激动的家庭照顾者的观察。141例患者中有2例出现谵妄体征（发生率1.4%）：一名80岁的男性，在局部麻醉和镇静下切除头部皮肤黑色素瘤后第1天出现定向障碍，言语不连贯和不合逻辑（咪达唑仑、舒芬太尼和丙泊酚），以及一名83岁的女性，既存精神错乱，在巩膜外阻滞下进行白内障手术后第2天出现幻视和幻听，并有不当行为。这两个病人回到他们的术前状态在几天内。结论：使用FAM-CAM仪器的检测术后谵妄在门诊患者，研究表明，在门诊设置的认知变化的发生率是非常低的。在几个假定的因素中，手术操作的轻便，区域麻醉的广泛使用和住院时间短可能是导致这一结果的因素。这项研究的结果需要在更大的患者样本中得到证实。
Background: While the incidence of postoperative delirium is high in aged hospitalized patients undergoing major surgery, little is known concerning patients undergoing ambulatory surgery.Objective: To determine the incidence of postoperative delirium in aged patients after hospital discharge from an ambulatory surgery unit.Design: Prospective observational study.Patients: Elderly patients (>= 75 years) scheduled for a surgical procedure on an ambulatory basis.Interventions: Filling of the Family Confusion Assessment Method (FAM-CAM) questionnaire (11 items) during a phone interview of family caregivers on two separate occasions: five to three days before surgery, and three to five days after surgery.Main outcome measures: The detection of acute onset and fluctuating course inattention, disorganized thinking, altered level of consciousness, disorientation, perceptual disturbances, and psychomotor agitation from the observations of family caregivers.Results: Signs of delirium appeared de novo in 2 of 141 patients (incidence 1.4%) in the postoperative period: a 80-years old man who was disoriented and had incoherent and illogical speech on postoperative day 1 of resection of a cephalic cutaneous melanoma under local anesthesia and sedation (midazolam, sufentanil, and propofol), and a 83-years old woman with a pre-existing mental confusion, who experienced visual and hearing hallucinations and had inappropriate behaviour on postoperative day 2 of cataract surgery performed under episcleral block. Both patients returned to their preoperative states within a few days.Conclusions: Using the FAM-CAM instrument for the detection of postoperative delirium in ambulatory patients, the study showed that the incidence of cognitive changes in the ambulatory setting is very low. Among several putative factors, the lightness of the surgical procedure, the wide use of regional anesthesia, and the short hospital stay may be contributing factors to this result. The findings of this study need to be confirmed in a larger sample of patients.