Relevance of Preoperative Cognitive Impairment for Predicting Postoperative Delirium in Surgical Medicine: A Prospective Cohort Study

被引:0
作者
Moellmann, Henriette Louise [1 ]
Alhammadi, Eman [1 ,2 ]
Olbrich, Philipp [3 ]
Frohnhofen, Helmut [4 ]
机构
[1] Univ Hosp Dusseldorf, Cranio and Maxillofacial Surg, Moorenstr 5, D-40225 Dusseldorf, Germany
[2] Dubai Hlth, POB 1853, Dubai, U Arab Emirates
[3] Heinrich Heine Univ Dusseldorf, Med Fac, Univ Str 1, D-40225 Dusseldorf, Germany
[4] Univ Hosp Dusseldorf, Orthoped & Trauma Surg, Moorenstr 5, D-40225 Dusseldorf, Germany
关键词
postoperative delirium; surgery; cognitive impairment; geriatric assessment; ANTICHOLINERGIC DRUG BURDEN; GERIATRIC ASSESSMENT; PRACTICES GUIDELINE; AMERICAN-COLLEGE; ELDERLY-PATIENTS; OUTCOMES; CARE; RISK; INTERVENTIONS; COMPLICATIONS;
D O I
10.3390/geriatrics9060155
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background: Post-operative delirium is a dreaded complication after surgery in older patients. The identification of risk factors for delirium and comprehensive geriatric assessment is an extensive part of recent research. However, the preoperative assessment of risk factors, such as impaired cognition, is frequently not standardized. Methods: A comprehensive preoperative assessment was performed in 421 surgical patients to investigate the impact of preoperative cognitive impairment (PCI) on the risk of delirium and to evaluate appropriate screening tools (Six-item screener (SIS) and clock-drawing test (CDT)). Results: Both screening tools showed a significantly increased risk of delirium with p < 0.001 (OR 12.5, 95% [6.42; 24.4]) in SIS and p = 0.042 (OR 2.02, 95%CI [1.02; 4.03]) in CDT for existing cognitive impairment. A higher level of care (p < 0.001) and statutory care (p < 0.001, OR 5.42, 95%CI [2.34; 12.6]) also proved to be significant risk factors. The ROC curves of the two tests show AUC values of 0.741 (SIS) and 0.630 (CDT). The COP values for the SIS are 4 points with a Youden index of 0.447; for the CDT, the COP is 2 (Youden index = 0.177). Conclusions: The recording of PCI should be a central component of the preoperative geriatric assessment. The tools used are simple yet effective and can be easily implemented in routine clinical practice. By reliably identifying patients at risk, the available resources can be personalized and used in a targeted approach.
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