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Abstract：
BACKGROUND: The management of preoperative blood glucose levels in reducing the incidence of postoperative delirium (POD) remains controversial. This study aims to investigate the impact of preoperative persistent hyperglycemia on POD in geriatric patients with hip fractures.
METHODS: This retrospective cohort study analyzed medical records of patients who underwent hip fracture surgery at a tertiary medical institution between January 2013 and November 2023. Patients were categorized based on preoperative hyperglycemia (hyperglycemia defined as ≥ 6.1mmol/L), clinical classification of hyperglycemia, and percentile thresholds. Multivariate logistic regression and propensity score matching analysis (PSM) were employed to assess the association between different levels of preoperative glucose and POD. Subgroup analysis was conducted to explore potential interactions.
RESULTS: A total of 1440 patients were included in this study, with an incidence rate of POD at 19.1% (275/1440). Utilizing multiple logistic analysis, we found that patients with hyperglycemia had a 1.65-fold increased risk of experiencing POD compared to those with normal preoperative glucose levels (95% CI: 1.17-2.32). Moreover, a significant upward trend was discerned in both the strength of association and the predicted probability of POD with higher preoperative glucose levels. PSM did not alter this trend, even after meticulous adjustments for potential confounding factors. Additionally, when treating preoperative glucose levels as a continuous variable, we observed a 6% increase in the risk of POD (95% CI: 1-12%) with each 1mmol/L elevation in preoperative glucose levels.
CONCLUSIONS: There exists a clear linear dose-response relationship between preoperative blood glucose levels and the risk of POD. Higher preoperative hyperglycemia was associated with a greater risk of POD.
BACKGROUND: NCT06473324.
METHODS: This retrospective cohort study analyzed medical records of patients who underwent hip fracture surgery at a tertiary medical institution between January 2013 and November 2023. Patients were categorized based on preoperative hyperglycemia (hyperglycemia defined as ≥ 6.1mmol/L), clinical classification of hyperglycemia, and percentile thresholds. Multivariate logistic regression and propensity score matching analysis (PSM) were employed to assess the association between different levels of preoperative glucose and POD. Subgroup analysis was conducted to explore potential interactions.
RESULTS: A total of 1440 patients were included in this study, with an incidence rate of POD at 19.1% (275/1440). Utilizing multiple logistic analysis, we found that patients with hyperglycemia had a 1.65-fold increased risk of experiencing POD compared to those with normal preoperative glucose levels (95% CI: 1.17-2.32). Moreover, a significant upward trend was discerned in both the strength of association and the predicted probability of POD with higher preoperative glucose levels. PSM did not alter this trend, even after meticulous adjustments for potential confounding factors. Additionally, when treating preoperative glucose levels as a continuous variable, we observed a 6% increase in the risk of POD (95% CI: 1-12%) with each 1mmol/L elevation in preoperative glucose levels.
CONCLUSIONS: There exists a clear linear dose-response relationship between preoperative blood glucose levels and the risk of POD. Higher preoperative hyperglycemia was associated with a greater risk of POD.
BACKGROUND: NCT06473324.
摘要：
背景：术前血糖水平的控制在降低术后谵妄（POD）发生率方面仍存在争议。本研究旨在探讨术前持续性高血糖对老年髋部骨折患者POD的影响。
方法：这项回顾性队列研究分析了2013年1月至2023年11月在三级医疗机构接受髋部骨折手术的患者的病历。根据术前高血糖（高血糖定义为≥6.1mmol/L）对患者进行分类。高血糖的临床分类，和百分位阈值。采用多因素logistic回归和倾向评分匹配分析(PSM)评估术前不同血糖水平与POD的相关性。进行亚组分析以探索潜在的相互作用。
结果：本研究共纳入1440例患者，POD发生率为19.1%(275/1440)。利用多元逻辑分析，我们发现,与术前血糖水平正常的患者相比,高血糖患者发生POD的风险增加1.65倍(95%CI:1.17~2.32).此外，术前血糖水平较高时,POD的关联强度和预测概率均呈显著上升趋势.PSM并没有改变这一趋势,即使对潜在的混杂因素进行了细致的调整。此外,将术前血糖水平视为连续变量时，我们观察到术前血糖水平每升高1mmol/L,POD风险增加6%(95%CI:1-12%).
结论：术前血糖水平与POD风险之间存在明显的线性剂量-反应关系。术前高血糖较高与POD风险较大相关。
背景：NCT06473324。
方法：这项回顾性队列研究分析了2013年1月至2023年11月在三级医疗机构接受髋部骨折手术的患者的病历。根据术前高血糖（高血糖定义为≥6.1mmol/L）对患者进行分类。高血糖的临床分类，和百分位阈值。采用多因素logistic回归和倾向评分匹配分析(PSM)评估术前不同血糖水平与POD的相关性。进行亚组分析以探索潜在的相互作用。
结果：本研究共纳入1440例患者，POD发生率为19.1%(275/1440)。利用多元逻辑分析，我们发现,与术前血糖水平正常的患者相比,高血糖患者发生POD的风险增加1.65倍(95%CI:1.17~2.32).此外，术前血糖水平较高时,POD的关联强度和预测概率均呈显著上升趋势.PSM并没有改变这一趋势,即使对潜在的混杂因素进行了细致的调整。此外,将术前血糖水平视为连续变量时，我们观察到术前血糖水平每升高1mmol/L,POD风险增加6%(95%CI:1-12%).
结论：术前血糖水平与POD风险之间存在明显的线性剂量-反应关系。术前高血糖较高与POD风险较大相关。
背景：NCT06473324。
