PDF(Pubmed)
Abstract：
OBJECTIVE: The surgical population is ageing and often frail. Frailty increases the risk for poor post-operative outcomes such as delirium, which carries significant morbidity, mortality and cost. Frailty is often measured in a binary manner, limiting pre-operative counselling. The goal of this study was to determine the relationship between categorical frailty severity level and post-operative delirium.
METHODS: We performed an analysis of a retrospective cohort of older adults from 12 January 2018 to 3 January 2020 admitted to a tertiary medical center for elective surgery. All participants underwent frailty screening prior to inpatient elective surgery with at least two post-operative delirium assessments. Planned ICU admissions were excluded. Procedures were risk-stratified by the Operative Stress Score (OSS). Categorical frailty severity level (Not Frail, Mild, Moderate, and Severe Frailty) was measured using the Edmonton Frail Scale. Delirium was determined using the 4 A\'s Test and Confusion Assessment Method-Intensive Care Unit.
RESULTS: In sum, 324 patients were included. The overall post-operative delirium incidence was 4.6% (15 individuals), which increased significantly as the categorical frailty severity level increased (2% not frail, 6% mild frailty, 23% moderate frailty; P < 0.001) corresponding to increasing odds of delirium (OR 2.57 [0.62, 10.66] mild vs. not frail; OR 12.10 [3.57, 40.99] moderate vs. not frail).
CONCLUSIONS: Incidence of post-operative delirium increases as categorical frailty severity level increases. This suggests that frailty severity should be considered when counselling older adults about their risk for post-operative delirium prior to surgery.
METHODS: We performed an analysis of a retrospective cohort of older adults from 12 January 2018 to 3 January 2020 admitted to a tertiary medical center for elective surgery. All participants underwent frailty screening prior to inpatient elective surgery with at least two post-operative delirium assessments. Planned ICU admissions were excluded. Procedures were risk-stratified by the Operative Stress Score (OSS). Categorical frailty severity level (Not Frail, Mild, Moderate, and Severe Frailty) was measured using the Edmonton Frail Scale. Delirium was determined using the 4 A\'s Test and Confusion Assessment Method-Intensive Care Unit.
RESULTS: In sum, 324 patients were included. The overall post-operative delirium incidence was 4.6% (15 individuals), which increased significantly as the categorical frailty severity level increased (2% not frail, 6% mild frailty, 23% moderate frailty; P < 0.001) corresponding to increasing odds of delirium (OR 2.57 [0.62, 10.66] mild vs. not frail; OR 12.10 [3.57, 40.99] moderate vs. not frail).
CONCLUSIONS: Incidence of post-operative delirium increases as categorical frailty severity level increases. This suggests that frailty severity should be considered when counselling older adults about their risk for post-operative delirium prior to surgery.
摘要：
目的：手术人群正在老龄化，并且通常很虚弱。虚弱会增加术后不良结局的风险，如谵妄，发病率很高，死亡率和成本。脆弱通常以二进制方式测量，限制术前咨询。这项研究的目的是确定分类虚弱严重程度与术后谵妄之间的关系。
方法：我们对2018年1月12日至2020年1月3日入住三级医疗中心择期手术的老年人进行了回顾性队列分析。所有参与者在住院择期手术前进行虚弱筛查，至少进行两次术后谵妄评估。计划的ICU入院被排除。手术通过手术压力评分(OSS)进行风险分层。分类脆弱严重程度(不脆弱，温和,中等,和严重虚弱）使用埃德蒙顿虚弱量表进行测量。使用4A测试和混乱评估方法-重症监护病房确定谵妄。
结果：总之，包括324名患者。术后谵妄总发生率为4.6%(15例),随着分类虚弱严重程度的增加，显着增加(2%不虚弱，6%轻度虚弱,23%中度虚弱；P<0.001）对应于谵妄的几率增加（OR2.57[0.62，10.66]轻度vs.不虚弱；或12.10[3.57，40.99]中度与不虚弱）。
结论：术后谵妄的发生率随着分类虚弱严重程度的增加而增加。这表明，在向老年人咨询手术前的术后谵妄风险时，应考虑虚弱的严重程度。
方法：我们对2018年1月12日至2020年1月3日入住三级医疗中心择期手术的老年人进行了回顾性队列分析。所有参与者在住院择期手术前进行虚弱筛查，至少进行两次术后谵妄评估。计划的ICU入院被排除。手术通过手术压力评分(OSS)进行风险分层。分类脆弱严重程度(不脆弱，温和,中等,和严重虚弱）使用埃德蒙顿虚弱量表进行测量。使用4A测试和混乱评估方法-重症监护病房确定谵妄。
结果：总之，包括324名患者。术后谵妄总发生率为4.6%(15例),随着分类虚弱严重程度的增加，显着增加(2%不虚弱，6%轻度虚弱,23%中度虚弱；P<0.001）对应于谵妄的几率增加（OR2.57[0.62，10.66]轻度vs.不虚弱；或12.10[3.57，40.99]中度与不虚弱）。
结论：术后谵妄的发生率随着分类虚弱严重程度的增加而增加。这表明，在向老年人咨询手术前的术后谵妄风险时，应考虑虚弱的严重程度。
