Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty
Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty
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DOI：
10.1186/s12891-020-03206-4
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发表时间：
2020-05-02
影响因子：
2.3
通讯作者：
Marumo, Keishi
中科院分区：
文献类型：
--
作者：
Kijima, Eiji;Kayama, Tomohiro;Marumo, Keishi
背景 谵妄是一种众所周知的手术后并发症，尤其是随着接受手术的患者年龄的增加。尽管健康预期寿命延长且存在合并症，但由于健康预期寿命的延长，需求不断增加，因此进行了更多的关节置换术。本研究的目的是探讨老年人群单侧和双侧全膝关节置换术中可能导致谵妄的各种危险因素。方法对170例接受单侧或双侧全膝关节置换术的患者谵妄情况进行回顾性分析。对年龄、性别、合并症、镇静催眠药的使用、围手术期失血量、术前和术后实验室血液检查结果进行调查和分析。结果 术后谵妄的发生率为 6.5%（170 名患者中的 11 名），平均年龄为 79.5 (+/- 6.9) 岁，而非谵妄组的平均年龄为 73.0 (+/- 9.0) 岁。谵妄组年龄较大、使用镇静催眠药、术前 Hb 和 Ht 较低、术后 Hb、Ht 和 BUN 较低。多因素logistic回归分析发现，镇静催眠药的使用和术前Hb水平是TKA术后谵妄的独立危险因素。使用镇静催眠药和术前 Hb 水平的比值比分别为 4.6 和 0.53。受试者工作特征曲线分析显示，术前 Hb 低于 11.1 g/dL 是发生谵妄的预测因子，敏感性为 54.6%，特异性为 91.6%。结论 术前 Hb 水平< 11.1 g/dL 或使用镇静催眠药的患者与术后谵妄相关。因此，需要围手术期管理和预防措施来降低此类患者术后谵妄的风险。
Background Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population. Methods 170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, peri-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed. Results The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (+/- 6.9) years, compared to 73.0 (+/- 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%. Conclusion Patients with a pre-operative Hb level of < 11.1 g/dL or those using sedative-hypnotics are associated with post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.