BACKGROUND Postoperative delirium(POD)is one of the most common complications in older adult patients undergoing elective surgery.Few studies have compared,within the same institution,the type of surgery,risk factors ...BACKGROUND Postoperative delirium(POD)is one of the most common complications in older adult patients undergoing elective surgery.Few studies have compared,within the same institution,the type of surgery,risk factors and type of anesthesia and analgesia associated with the development of POD.AIM To investigate the following three questions:(1)What is the incidence of POD after non-ambulatory orthopedic surgery at a high-volume orthopedic specialty hospital?(2)Does surgical procedure influence incidence of POD after nonambulatory orthopedic surgery?And(3)For POD after non-ambulatory orthopedic surgery,what are modifiable risk factors?METHODS A retrospective cohort study was conducted of all non-ambulatory orthopedic surgeries at a single orthopedic specialty hospital between 2009 and 2014.Patients under 18 years were excluded from the cohort.Patient characteristics and medical history were obtained from electronic medical records.Patients with POD were identified using International Classification of Diseases,9^th Revision(ICD-9)codes that were not present on admission.For incidence analyses,the cohort was grouped into total hip arthroplasty(THA),bilateral THA,total knee arthroplasty(TKA),bilateral TKA,spine fusion,other spine procedures,femur/pelvic fracture,and other procedures using ICD-9 codes.For descriptive and regression analyses,the cohort was grouped,using ICD-9 codes,into THA,TKA,spinal fusions,and all procedures.RESULTS Of 78492 surgical inpatient surgeries,the incidence from 2009 to 2014 was 1.2%with 959 diagnosed with POD.The incidence of POD was higher in patients undergoing spinal fusions(3.3%)than for patients undergoing THA(0.8%);THA patients had the lowest incidence.Also,urgent and/or emergent procedures,defined by femoral and pelvic fractures,had the highest incidence of POD(7.2%)than all other procedures.General anesthesia was not seen as a significant risk factor for POD for any procedure type;however,IV patient-controlled analgesia was a significant risk factor for patients undergoing THA[Odds ratio(OR)=1.98,95%confidence interval(CI):1.19 to 3.28,P=0.008].Significant risk factors for POD included advanced age(for THA,OR=4.9,95%CI:3.0-7.9,P<0.001;for TKA,OR=2.16,95%CI:1.58-2.94,P<0.001),American Society of Anesthesiologists score of 3 or higher(for THA,OR=2.01,95%CI:1.33-3.05,P<0.001),multiple medical comorbidities,hyponatremia(for THA,OR=2.36,95%CI:1.54 to 3.64,P<0.001),parenteral diazepam(for THA,OR=5.05,95%CI:1.5-16.97,P=0.009;for TKA,OR=4.40,95%CI:1.52-12.75,P=0.007;for spine fusion,OR=2.17,95%CI:1.19-3.97,P=0.01),chronic opioid dependence(for THA,OR=7.11,95%CI:3.26-15.51,P<0.001;for TKA,OR=2.98,95%CI:1.38-6.41,P=0.005)and alcohol dependence(for THA,OR=5.05,95%CI:2.72-9.37,P<0.001;for TKA,OR=6.40,95%CI:4.00-10.26,P<0.001;for spine fusion,OR=6.64,95%CI:3.72-11.85,P<0.001).CONCLUSION POD is lower(1.2%)than previously reported;likely due to the use of multimodal regional anesthesia and early ambulation.Both fixed and modifiable factors are identified.展开更多
目的构建急性脑卒中患者卒中后谵妄(post-stroke delirium,PSD)列线图预测模型,并验证其预测效果。方法2022年6月至2023年3月长沙市某三级甲等综合医院神经内科收治的400例急性脑卒中患者(训练集)作为研究对象,采用Logistic回归分析筛选...目的构建急性脑卒中患者卒中后谵妄(post-stroke delirium,PSD)列线图预测模型,并验证其预测效果。方法2022年6月至2023年3月长沙市某三级甲等综合医院神经内科收治的400例急性脑卒中患者(训练集)作为研究对象,采用Logistic回归分析筛选PSD的危险因素,并构建列线图预测模型,采用Calibration图检测模型的一致性,用ROC曲线下面积(area under curve,AUC)来评估预测模型准确性。另选取2023年4月至7月172例急性脑卒中患者(验证集)对模型进行外部验证。结果训练集患者PSD发生率为27.50%,验证集为26.74%。基于年龄、脑血管介入手术、超敏C反应蛋白、吸烟、美国国立卫生研究院脑卒中量表(National Institutes of health stroke scale,NIHSS)得分等5个预测因素构建列线图预测模型,Calibration图示校准曲线与理想曲线接近重合,AUC为0.797,最大Youden指数所对应的风险预测值为0.554,预测临界值为134.63分。验证集Calibration图示校准曲线与理想曲线接近,AUC为0.844。结论该模型具有较好的风险预测价值,可帮助医护人员有效预测急性脑卒中患者卒中后谵妄发生风险并采取相应的预防措施。展开更多
文摘BACKGROUND Postoperative delirium(POD)is one of the most common complications in older adult patients undergoing elective surgery.Few studies have compared,within the same institution,the type of surgery,risk factors and type of anesthesia and analgesia associated with the development of POD.AIM To investigate the following three questions:(1)What is the incidence of POD after non-ambulatory orthopedic surgery at a high-volume orthopedic specialty hospital?(2)Does surgical procedure influence incidence of POD after nonambulatory orthopedic surgery?And(3)For POD after non-ambulatory orthopedic surgery,what are modifiable risk factors?METHODS A retrospective cohort study was conducted of all non-ambulatory orthopedic surgeries at a single orthopedic specialty hospital between 2009 and 2014.Patients under 18 years were excluded from the cohort.Patient characteristics and medical history were obtained from electronic medical records.Patients with POD were identified using International Classification of Diseases,9^th Revision(ICD-9)codes that were not present on admission.For incidence analyses,the cohort was grouped into total hip arthroplasty(THA),bilateral THA,total knee arthroplasty(TKA),bilateral TKA,spine fusion,other spine procedures,femur/pelvic fracture,and other procedures using ICD-9 codes.For descriptive and regression analyses,the cohort was grouped,using ICD-9 codes,into THA,TKA,spinal fusions,and all procedures.RESULTS Of 78492 surgical inpatient surgeries,the incidence from 2009 to 2014 was 1.2%with 959 diagnosed with POD.The incidence of POD was higher in patients undergoing spinal fusions(3.3%)than for patients undergoing THA(0.8%);THA patients had the lowest incidence.Also,urgent and/or emergent procedures,defined by femoral and pelvic fractures,had the highest incidence of POD(7.2%)than all other procedures.General anesthesia was not seen as a significant risk factor for POD for any procedure type;however,IV patient-controlled analgesia was a significant risk factor for patients undergoing THA[Odds ratio(OR)=1.98,95%confidence interval(CI):1.19 to 3.28,P=0.008].Significant risk factors for POD included advanced age(for THA,OR=4.9,95%CI:3.0-7.9,P<0.001;for TKA,OR=2.16,95%CI:1.58-2.94,P<0.001),American Society of Anesthesiologists score of 3 or higher(for THA,OR=2.01,95%CI:1.33-3.05,P<0.001),multiple medical comorbidities,hyponatremia(for THA,OR=2.36,95%CI:1.54 to 3.64,P<0.001),parenteral diazepam(for THA,OR=5.05,95%CI:1.5-16.97,P=0.009;for TKA,OR=4.40,95%CI:1.52-12.75,P=0.007;for spine fusion,OR=2.17,95%CI:1.19-3.97,P=0.01),chronic opioid dependence(for THA,OR=7.11,95%CI:3.26-15.51,P<0.001;for TKA,OR=2.98,95%CI:1.38-6.41,P=0.005)and alcohol dependence(for THA,OR=5.05,95%CI:2.72-9.37,P<0.001;for TKA,OR=6.40,95%CI:4.00-10.26,P<0.001;for spine fusion,OR=6.64,95%CI:3.72-11.85,P<0.001).CONCLUSION POD is lower(1.2%)than previously reported;likely due to the use of multimodal regional anesthesia and early ambulation.Both fixed and modifiable factors are identified.
文摘目的构建急性脑卒中患者卒中后谵妄(post-stroke delirium,PSD)列线图预测模型,并验证其预测效果。方法2022年6月至2023年3月长沙市某三级甲等综合医院神经内科收治的400例急性脑卒中患者(训练集)作为研究对象,采用Logistic回归分析筛选PSD的危险因素,并构建列线图预测模型,采用Calibration图检测模型的一致性,用ROC曲线下面积(area under curve,AUC)来评估预测模型准确性。另选取2023年4月至7月172例急性脑卒中患者(验证集)对模型进行外部验证。结果训练集患者PSD发生率为27.50%,验证集为26.74%。基于年龄、脑血管介入手术、超敏C反应蛋白、吸烟、美国国立卫生研究院脑卒中量表(National Institutes of health stroke scale,NIHSS)得分等5个预测因素构建列线图预测模型,Calibration图示校准曲线与理想曲线接近重合,AUC为0.797,最大Youden指数所对应的风险预测值为0.554,预测临界值为134.63分。验证集Calibration图示校准曲线与理想曲线接近,AUC为0.844。结论该模型具有较好的风险预测价值,可帮助医护人员有效预测急性脑卒中患者卒中后谵妄发生风险并采取相应的预防措施。
