背景:术后谵妄(POD)是大手术后常见的并发症,可引起多种不良反应。然而,没有大规模的国家数据库用于评估肝切除术后谵妄(POD)的发生率和相关因素.
方法:使用国家住院患者样本(NIS)数据库中的国际疾病分类(ICD)第10版临床修改代码对2015年至2019年接受肝切除术的患者进行筛查。筛选与谵妄相关的围手术期因素,并进行统计分析,以确定肝切除术后谵妄的独立预测因素。
结果:从2015年到2019年,共有80,070例患者在五年内接受了肝切除术。肝切除术后POD的总发生率为1.46%(1039例),每年都有轻微的上升趋势。选择性入学的发生率降低了6.66%(88.60%与81.94%)比肝切除术后无POD的患者和2.34%(45.53%vs.43.19%)高于教学医院无POD患者(P<0.001)。此外,POD患者年龄大于6岁(67vs.61年),占9.27%(56.69%与47.42%)与未受影响的人群相比,男性患者更多(P<0.001)。此外,POD的发生与住院时间延长相关(13vs.5天;P<0.001),总成本较高(1,481,89美元与683,90美元;P<0.001),和更高的住院死亡率(12.61%vs.4.11%;P<0.001)。多因素logistic回归确定了POD的肝切除独立危险因素,包括非择期住院,教学医院,年龄较大,男性,抑郁症,液体和电解质紊乱,凝血病,其他神经系统疾病,精神病患者,和减肥。此外,肝切除术后的POD与脓毒症有关,痴呆症,尿潴留,胃肠道并发症,急性肾功能衰竭,肺炎,持续有创机械通气,输血,呼吸衰竭,和伤口开裂/不愈合。
结论:尽管肝切除术后POD的发生率相对较低,调查POD的诱发因素对优化护理管理和改善该患者人群的预后是有益的.
BACKGROUND: Postoperative delirium (POD) is a common complication after major surgery and can cause a variety of adverse effects. However, no large-scale national database was used to assess the occurrence and factors associated with postoperative delirium (POD) following hepatic resection.
METHODS: Patients who underwent hepatic resection from 2015 to 2019 were screened using the International Classification of Diseases (ICD) 10th edition clinical modification code from the National Inpatient Sample (NIS) Database. Peri-operative factors associated with delirium were screened and underwent statistical analysis to identify independent predictors for delirium following hepatic resection.
RESULTS: A total of 80,070 patients underwent hepatic resection over a five-year period from 2015 to 2019. The overall occurrence of POD after hepatic resection was 1.46% (1039 cases), with a slight upward trend every year. The incidence of elective admission was 6.66% lower (88.60% vs. 81.94%) than that of patients without POD after hepatic resection and 2.34% (45.53% vs. 43.19%) higher than that of patients without POD in teaching hospitals (P < 0.001). In addition, POD patients were 6 years older (67 vs. 61 years) and comprised 9.27% (56.69% vs. 47.42%) more male patients (P < 0.001) compared to the unaffected population. In addition, the occurrence of POD was associated with longer hospitalization duration (13 vs. 5 days; P < 0.001), higher total cost ($1,481,89 vs. $683,90; P < 0.001), and higher in-hospital mortality (12.61% vs. 4.11%; P < 0.001). Multivariate logistic regression identified hepatic resection-independent risk factors for POD, including non-elective hospital admission, teaching hospital, older age, male sex, depression, fluid and electrolyte disorders, coagulopathy, other neurological disorders, psychoses, and weight loss. In addition, the POD after hepatic resection has been associated with sepsis, dementia, urinary retention, gastrointestinal complications, acute renal failure, pneumonia, continuous invasive mechanical ventilation, blood transfusion, respiratory failure, and wound dehiscence / non-healing.
CONCLUSIONS: Although the occurrence of POD after hepatic resection is relatively low, it is beneficial to investigate factors predisposing to POD to allow optimal care management and improve the outcomes of this patient population.