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Liu T, Tuo J, Wei Q, Sun X, Zhao H, Zhao X, Qu M. Effect of Perioperative Dexmedetomidine Infusion on Postoperative Delirium in Elderly Patients Undergoing Oral and Maxillofacial Surgery: A Randomized Controlled Clinical Trial. Int J Gen Med 2022; 15:6105-6113. [PMID: 35846796 PMCID: PMC9278972 DOI: 10.2147/ijgm.s370237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of the study was to determine whether perioperative dexmedetomidine administration can improve postoperative delirium in elderly patients undergoing oral and maxillofacial surgery. Patients and Methods This was a prospective double-blind randomized controlled clinical trial conducted in Cangzhou Central Hospital from December 2021 to March 2022. Patients aged 65 and older underwent oral and maxillofacial surgery under general anesthesia. Eligible patients were randomly assigned to dexmedetomidine or control group. Dexmedetomidine was injected intravenously from 10 min before induction of anesthesia to 30 min before the end of surgery in dexmedetomidine group, while patients in the control group were given normal saline at the same rate during the same time period. The primary measurement indicators were the incidence and duration of delirium in the first five days after surgery. The secondary measurement indicators were Visual Analogue Score (VAS) for the first 24 hours following surgery, subjective sleep quality score within 24 hours postoperatively and intraoperative adverse reactions. Results One hundred and twenty patients were randomly assigned. Baseline characteristics were similar between two groups. The incidence and duration of postoperative delirium did not differ statistically between two groups (all P > 0.05). Compared with control group, VAS scores in dexmedetomidine group were significantly lower at 6, 12, and 24 hours after surgery (all P < 0.05); moreover, Richards-Campbell Sleep Questionnaire (RCSQ) results were significantly improved 1 day after surgery in dexmedetomidine group (P < 0.05). Dexmedetomidine-related adverse reactions were similar in both groups (P > 0.05). Conclusion Intravenous infusion of dexmedetomidine 10 min before induction of anesthesia to half an hour before the end of surgery did not improve postoperative delirium in elderly patients undergoing oral and maxillofacial surgery; however, dexmedetomidine may be associated with decreased postoperative pain and improved postoperative sleep quality.
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Affiliation(s)
- Tianlin Liu
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, People's Republic of China
| | - Jingtang Tuo
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, People's Republic of China
| | - Qianjie Wei
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, People's Republic of China
| | - Xiuwei Sun
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, People's Republic of China
| | - Haochen Zhao
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, People's Republic of China
| | - Xiaochen Zhao
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, People's Republic of China
| | - Min Qu
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, People's Republic of China
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Fu X, Wang L, Wang G, Liu X, Wang X, Ma S, Miao F. Delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation: a prospective cohort study. BMC Pulm Med 2022; 22:266. [PMID: 35810306 PMCID: PMC9271245 DOI: 10.1186/s12890-022-02052-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background COPD combined with respiratory failure is very common in intensive care unit (ICU). We aimed to evaluate the current status and influencing factors of delirium in elderly COPD patients with undergoing mechanical ventilation. Methods Patients with COPD combined with respiratory failure and mechanically ventilated who were admitted to the ICU of our hospital were selected. The characteristics of included patients were assessed. Pearson correlation analysis was performed to evaluate the characteristics of patients and delirium. Logistic regression analysis was conducted to identify the risk factors of delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation. Results A total of 237 COPD combined with respiratory failure patients were included, the incidence of delirium was 21.94%. Pearson correlation analysis indicated that age (r = 0.784), BMI (r = 0.709), hypertension (r = 0.696), APACHE II score (r = 0.801), CPOT (r = 0.513), sedation(r = 0.626) and PaO2 (r = 0.611) were all correlated with the occurrence of delirium (all p < 0.05). Logistic regression analysis indicated that age ≥ 75y (OR 3.112, 95% CI 2.144–4.602), BMI ≤ 19 kg/m2 (OR 2.742, 95% CI 1.801–3.355), hypertension(OR 1.909, 95% CI 1.415–2.421), APACHE II score ≥ 15 (OR 2.087, 95% CI 1.724–2.615), CPOT ≥ 5 (OR 1.778, 95% CI 1.206–2.641), sedation(OR 3.147, 95% CI 2.714–3.758), PaO2 ≤ 75 mmHg(OR 2.196, 95%CI 1.875–3.088) were the risk factors of delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation (all p < 0.05). Conclusions Delirium is common in patients with COPD and respiratory failure undergoing mechanical ventilation, and there are many related influencing factors. Medical staff should pay more attention to patients with risk factors and take intervention measures as soon as possible to reduce the incidence of delirium.
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Affiliation(s)
- Xuecai Fu
- Geriatrics Department, Aerospace Center Hospital, No 15 Yuquan Road, Haidian District, Beijing, China
| | - Lina Wang
- Geriatrics Department, Aerospace Center Hospital, No 15 Yuquan Road, Haidian District, Beijing, China
| | - Guihua Wang
- Geriatrics Department, Aerospace Center Hospital, No 15 Yuquan Road, Haidian District, Beijing, China
| | - Xuefang Liu
- Geriatrics Department, Aerospace Center Hospital, No 15 Yuquan Road, Haidian District, Beijing, China
| | - Xin Wang
- Geriatrics Department, Aerospace Center Hospital, No 15 Yuquan Road, Haidian District, Beijing, China
| | - Shuiting Ma
- Geriatrics Department, Aerospace Center Hospital, No 15 Yuquan Road, Haidian District, Beijing, China
| | - Fengru Miao
- Geriatrics Department, Aerospace Center Hospital, No 15 Yuquan Road, Haidian District, Beijing, China.
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Lee CH, Cho SA, Oh SK, Choi SS, Kong MH, Kim YS. The usefulness of dual channel elastomeric pump for intravenous patient-controlled analgesia in geriatrics: a randomized, double-blind, prospective study. BMC Anesthesiol 2022; 22:210. [PMID: 35799106 PMCID: PMC9261015 DOI: 10.1186/s12871-022-01733-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intravenous patient-controlled analgesia (IV-PCA) is often used in the postoperative period. However, determining an appropriate opioid dose is difficult. A previous study suggested the usefulness of variable-rate feedback infusion. In this study, we used a dual-channel elastomeric infusion pump to provide changes in PCA infusion rate by pain feedback. METHODS Ninety patients undergoing orthopedic surgery of American Society of Anesthesiologists grade I-III and 65 to 79 years of age participated in the study. All patients were given a dual-chamber PCA. Patients were randomly allocated to a treatment group (Group D; PCA drugs divided into both chambers) or control group (Group C; PCA drugs only in the constant flow chamber with normal saline in the adjustable flow chamber). The primary outcome was the amount of fentanyl consumption via PCA bolus. The secondary outcome variables were pain score, total fentanyl consumption, rescue analgesic use, patient satisfaction, recovery scores, and adverse events including postoperative nausea and vomiting (PONV). RESULTS Group D showed decreased fentanyl consumption of the PCA bolus, a decrease in rescue analgesic use, and better patient satisfaction compared with group C. The incidence of PONV was much higher in group C. There was no difference in other adverse events. CONCLUSIONS We showed the usefulness of dual chamber IV-PCA to change the flow rate related to pain feedback without any complications. Our results suggest a noble system that might improve existing IV-PCA equipment. TRIAL REGISTRATION The study registered at UMIN clinical trial registry (registered date: 05/03/2020, registration number: UMIN000039702 ).
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Affiliation(s)
- Chung Hun Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Soo Ah Cho
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Seok Kyeong Oh
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Sang Sik Choi
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Myoung Hoon Kong
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Young Sung Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea.
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Zhou S, Shi S, Xie C, Chen G. Association between smoking and postoperative delirium in surgical patients with pulmonary hypertension: a secondary analysis of a cohort study. BMC Psychiatry 2022; 22:371. [PMID: 35650551 PMCID: PMC9158079 DOI: 10.1186/s12888-022-03981-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/05/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have declared that smoking was a risk factor for postoperative delirium (POD), but others have inconsistent results. Up till now, the association between smoking and POD has not been verified. This study investigates the relationship between smoking and POD in patients with pulmonary hypertension (PHTN) in the United States. METHODS Patients with PHTN who underwent non-cardiac, non-obstetric surgery were enrolled in the original research completed by Aalap C. et al. We further excluded the patients undergoing intracranial surgery and the patients with sepsis and perioperative stroke to avoid interference with POD assessment. The generalized linear model and generalized additive model were used to explore the relationship between smoking and POD. The propensity score adjustment was used for sensitivity analyses. RESULTS Five hundred thirty-nine patients were included in this study. The overall incidence of POD was 3.0% (16/539). After adjusting the potential confounders (age, systemic hypertension, coronary artery disease, COPD, length of surgery, intrathoracic surgery, vascular surgery), a positive relationship was found between smoking status and POD (OR = 4.53, 95% CI: 1.22 to 16.86, P = 0.0243). In addition, the curvilinear relationship between smoking burden (pack-years) and POD is close to a linear relationship. CONCLUSION Smoking probably shows a positive correlation with POD in patients with PHTN.
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Affiliation(s)
- Sai Zhou
- grid.464229.f0000 0004 1765 8757Academic Affairs Department, Changsha Medical University, Changsha, 410000 Hunan China
| | - Shuqing Shi
- grid.431010.7Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, 410013 Hunan China
| | - Chang Xie
- grid.431010.7Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, 410013 Hunan China
| | - Gong Chen
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China.
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Kong H, Xu LM, Wang DX. Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment. CNS Neurosci Ther 2022; 28:1147-1167. [PMID: 35652170 PMCID: PMC9253756 DOI: 10.1111/cns.13873] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 12/13/2022] Open
Abstract
Perioperative neurocognitive disorders (NCDs) refer to neurocognitive abnormalities detected during the perioperative periods, including preexisting cognitive impairment, preoperative delirium, delirium occurring up to 7 days after surgery, delayed neurocognitive recovery, and postoperative NCD. The Diagnostic and Statistical Manual of Mental Disorders‐5th edition (DSM‐5) is the golden standard for diagnosing perioperative NCDs. Given the impracticality of using the DSM‐5 by non‐psychiatric practitioners, many diagnostic tools have been developed and validated for different clinical scenarios. The etiology of perioperative NCDs is multifactorial and includes predisposing and precipitating factors. Identifying these risk factors is conducive to preoperative risk stratification and perioperative risk reduction. Prevention for perioperative NCDs should include avoiding possible contributors and implementing nonpharmacologic and pharmacological interventions. The former generally includes avoiding benzodiazepines, anticholinergics, prolonged liquid fasting, deep anesthesia, cerebral oxygen desaturation, and intraoperative hypothermia. Nonpharmacologic measures include preoperative cognitive prehabilitation, comprehensive geriatric assessment, implementing fast‐track surgery, combined use of regional block, and sleep promotion. Pharmacological measures including dexmedetomidine, nonsteroidal anti‐inflammatory drugs, and acetaminophen are found to have beneficial effects. Nonpharmacological treatments are the first‐line measures for established perioperative NCDs. Pharmacological treatments are still limited to severely agitated or distressed patients.
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Affiliation(s)
- Hao Kong
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Long-Ming Xu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China.,Outcomes Research Consortium, Cleveland, Ohio, USA
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Abstract
PURPOSE OF REVIEW Perioperative neurocognitive disorders (PNDs) are among the most frequent complications after surgery and are associated with considerable morbidity and mortality. We analysed the recent literature regarding risk assessment of PND. RECENT FINDINGS Certain genetic variants of the cholinergic receptor muscarinic 2 and 4, as well as a marked degree of frailty but not the kind of anaesthesia (general or spinal) are associated with the risk to develop postoperative delirium (POD). Models predict POD with a discriminative power, for example, area under the receiver operating characteristics curve between 0.52 and 0.94. SUMMARY Advanced age as well as preexisting cognitive, functional and sensory deficits remain to be the main risk factors for the development of PND. Therefore, aged patients should be routinely examined for both preexisting and new developing deficits, as recommended in international guidelines. Appropriate tests should have a high discrimination rate, be feasible to be administered by staff that do not require excessive training, and only take a short time to be practical for a busy outpatient clinic. Models to predict PND, should be validated appropriately (and externally if possible) and should not contain a too large number of predictors to prevent overfitting of models.
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Thisayakorn P, Thipakorn Y, Tantavisut S, Sirivichayakul S, Maes M. Delirium due to hip fracture is associated with activated immune-inflammatory pathways and a reduction in negative immunoregulatory mechanisms. BMC Psychiatry 2022; 22:369. [PMID: 35641947 PMCID: PMC9158285 DOI: 10.1186/s12888-022-04021-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/25/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The objectives of this study were to delineate whether delirium in older adults is associated with activation of the immune-inflammatory response system (IRS) as indicated by activation of M1, T helper (Th)1, and Th17 profiles, and/or by reduced activities of the compensatory immunoregulatory system (CIRS), including Th2 and T regulatory profiles. METHODS We recruited 65 older adult patients with a low energy impact hip fracture who underwent hip fracture operation. The CAM-ICU and the Delirium Rating Scale, Revised-98-Thai version (DRS-R-98) were assessed pre-operatively and 1, 2 and 3 days after surgery. Blood samples (day 1 and 2) post-surgery were assayed for cytokines/chemokines using a MultiPlex assay and the neutrophil/lymphocyte ratio. RESULTS We found that delirium and/or the DRS-R-98 score were associated with IRS activation as indicated by activated M1, Th1, Th17 and T cell growth profiles and by attenuated CIRS functions. The most important IRS biomarkers were CXCL8, interleukin (IL)-6, and tumor necrosis factor-α, and the most important CIRS biomarkers were IL-4 and soluble IL-1 receptor antagonist. We found that 42.5% of the variance in the actual changes in the DRS-R-98 score (averaged from day 1 to day 3) was explained by T cell growth factors, baseline DRS-R-98 scores and age. An increase in the NLR reflects overall IRS, M1, Th1, Th17, and Th2 activation. CONCLUSIONS Post-hip surgery delirium is associated with activated IRS pathways and appears especially in patients with lowered CIRS functions.
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Affiliation(s)
- Paul Thisayakorn
- Department of Psychiatry, Hip Fracture Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Yanin Thipakorn
- grid.7922.e0000 0001 0244 7875Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Saran Tantavisut
- grid.7922.e0000 0001 0244 7875Department of Orthopedics, Hip Fracture Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sunee Sirivichayakul
- grid.7922.e0000 0001 0244 7875Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria. .,IMPACT Strategic Research Center, Deakin University, Geelong, Australia.
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Salottolo K, Meinig R, Fine L, Kelly M, Madayag R, Ekengren F, Tanner A, Bar-Or D. Associations of Smoking With Delirium and Opioid Use in Older Adults With Traumatic Hip Fracture. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e21.00188. [PMID: 35576240 PMCID: PMC10566843 DOI: 10.5435/jaaosglobal-d-21-00188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Cigarette smoking is a risk factor for hip fractures, while risk factors for developing delirium include older age and preexisting cognitive impairment. We sought to determine whether smoking status is independently associated with delirium and pain outcomes. METHODS This was a prospective, observational cohort study of 442 older adults (65 to 90 years) admitted for traumatic hip fracture at five trauma centers. The primary exposure was smoking status (n = 43, 10%). Additional risk factors included demographics, injury characteristics, and medical interventions. Delirium (primary) and analgesia-related complications were examined with multivariable logistic regression, while analysis of covariance models were used to examine preoperative and postoperative pain scores and opioid consumption (oral morphine equivalents). RESULTS Smokers had significantly worse outcomes compared with nonsmokers: delirium incidence was 16.3% versus 5.0% (adjusted odds ratio, 4.23; P = 0.005), analgesia complications developed in 30.2% versus 14.8% (adjusted odds ratio, 2.63; P = 0.01), and postoperative opioid consumption was greater (53 mg versus 33 mg, adjusted P = 0.04). Adjusted pain scores were not different between groups. DISCUSSION Smoking status is associated with markedly worse outcomes in older adults with traumatic hip fracture. Smoking status should be considered in pain management protocols and for early screening and delirium prevention methods. DATA AVAILABILITY On reasonable request.
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Affiliation(s)
- Kristin Salottolo
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - Richard Meinig
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - Landon Fine
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - Michael Kelly
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - Robert Madayag
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - Francie Ekengren
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - Allen Tanner
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
| | - David Bar-Or
- From the Trauma Research Department, Penrose Hospital, Colorado Springs, CO (Salottolo, Dr. Meinig, Kelly, Dr. Tanne II, and Dr. Bar-Or); the Trauma Research Department, St Anthony Hospital, Lakewood, CO (Salottolo, Dr. Madayag, and Dr. Bar-Or); the Trauma Research Department, Wesley Medical Center, Wichita, KS (Salottolo, Dr. Ekengren, and Dr. Bar-Or); the Trauma Research Department, St. Francis Medical Center, Colorado Springs, CO (Dr. Meinig); and the Trauma Research Department, Parker Adventist Hospital, Parker, CO (Dr. Fine)
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Becker N, Hafner T, Pishnamaz M, Hildebrand F, Kobbe P. Patient-specific risk factors for adverse outcomes following geriatric proximal femur fractures. Eur J Trauma Emerg Surg 2022; 48:753-761. [PMID: 35325262 PMCID: PMC9001566 DOI: 10.1007/s00068-022-01953-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Proximal femur fractures (PFFs) occur frequently among geriatric patients due to diverse risk factors, such as a lower bone mineral density and the increased risk of falls. METHODS In this review, we focus on recent literature of patient-specific risk factors and their impact on common complications and outcome parameters in patients with PFF. RESULTS Patient- and treatment related factors have a significant impact on outcome and are associated with an increased risk of mortality, impairments in functional rehabilitation and complicative courses. CONCLUSION Geriatric patients at high risk for complications are nursing home inhabitants suffering from severe osteoporosis, dementia and sarcopenia. The early and ongoing assessment for these individual risk factors is crucial. Strategies including interdisciplinary approaches, addressing comorbidities and facilitating an optimal risk factor evaluation result in a beneficial outcome. The ongoing ambulant assessment and therapy of complicating factors (e.g., malnutrition, sarcopenia, frailty or osteoporosis) have to be improved.
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Affiliation(s)
- Nils Becker
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Tobias Hafner
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Miguel Pishnamaz
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Philipp Kobbe
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Fanelli A, Balzani E, Memtsoudis S, Abdallah FW, Mariano ER. Regional anesthesia techniques and postoperative delirium: systematic review and meta-analysis. Minerva Anestesiol 2022; 88:499-507. [PMID: 35164487 DOI: 10.23736/s0375-9393.22.16076-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Postoperative delirium is a frequent occurrence in the elderly surgical population. As a comprehensive list of predictive factors remains unknown, an opioid-sparing approach incorporating regional anesthesia techniques has been suggested to decrease its incidence. Due to the lack of conclusive evidence on the topic, we conducted a systematic review and meta-analysis to investigate the potential impact of regional anesthesia and analgesia on postoperative delirium. EVIDENCE ACQUISITION PubMed, Embase, and the Cochrane central register of Controlled trials (CENTRAL) databases were searched for randomized trials comparing regional anesthesia or analgesia to systemic treatments in patients having any type of surgery. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We pooled the results separately for each of these two applications by random effects modelling. Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the certainty of evidence and strength of conclusions. EVIDENCE SYNTHESIS Eighteen trials (3361 subjects) were included. Using regional techniques for surgical anesthesia failed to reduce the risk of postoperative delirium, with a relative risk (RR) of 1.21 (95% CI: 0.79 to 1.85); P=0.3800. In contrast, regional analgesia reduced the relative risk of perioperative delirium by a RR of 0.53 (95% CI: 0.42 to 0.68; P<0.0001), when compared to systemic analgesia. Post-hoc subgroup analysis for hip fracture surgery yielded similar findings. CONCLUSIONS These results show that postoperative delirium may be decreased when regional techniques are used in the postoperative period as an analgesic strategy. Intraoperative regional anesthesia alone may not decrease postoperative delirium since there are other factors that may influence this outcome.
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Affiliation(s)
- Andrea Fanelli
- Anesthesia, Intensive Care and Pain Therapy Unit, Department of Emergency and Urgency, Istituto ad Alta Specializzazione Policlinico di Monza, Monza, Monza-Brianza, Italy -
| | - Eleonora Balzani
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | | | - Edward R Mariano
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada
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Liu YM, Huang H, Gao J, Zhou J, Chu HC. Hemoglobin Concentration and Post-Operative Delirium in Elderly Patients Undergoing Femoral Neck Fracture Surgery. Front Med (Lausanne) 2022; 8:780196. [PMID: 35071265 PMCID: PMC8766508 DOI: 10.3389/fmed.2021.780196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/03/2021] [Indexed: 02/05/2023] Open
Abstract
This study aimed to determine the relationship between hemoglobin (Hb) concentration and post-operative delirium (POD) in elderly patients undergoing femoral neck fracture (FNF) surgery and to investigate whether the change in Hb concentration is associated with POD and the risk factors for POD. A total of 889 patients admitted with FNF between January 2016 and December 2020 were enrolled in this single-center, retrospective, case–control study. Hb concentrations were determined at admission and post-operative day 1 and the change in Hb concentration was defined as the absolute value of difference in pre-operative and post-operative Hb concentration. POD was assessed using the Confusion Assessment Method for the Intensive Care Unit (ICU) or the Confusion Assessment Method once a daily after surgery. The logistic regression analysis was performed for statistical analysis. In total, 172 (19.3%) patients developed POD and 151 (87.8%) patients developed POD within post-operative 3 days. Low pre-operative Hb concentration [p = 0.026, odds ratio (OR) = 0.978] and significant change in Hb concentration (p = 0.006, OR = 1.033) were significantly associated with POD. After excluding change in Hb concentration or pre-operative Hb concentration, neither of them was significantly associated with POD (p > 0.05). The interaction analysis of change in Hb concentration and pre-operative Hb concentration in the logistic regression model was negative. There was no significant relationship between post-operative Hb concentration and POD. Age (p < 0.001, OR = 1.072), stroke history (p = 0.003, OR = 2.489), post-operative ICU transfer (p = 0.007, OR = 1.981), and visual analog scale score within post-operative 2 days (p1 = 0.016 and p2 = 0.006) were independently associated with POD in the logistic regression analysis. Patients with low pre-operative Hb concentrations and high changes in Hb concentration seem to have an increased risk of POD and should receive more attention. Old age, stroke history, post-operative ICU transfer, and pain within post-operative 2 days were significantly associated with POD.
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Affiliation(s)
- Yu-Mei Liu
- School of Clinical Medicine, Qingdao University, Qingdao, China
| | - Hui Huang
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, School of Clinical Medicine, Qingdao University, Qingdao, China
| | - Jie Gao
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, School of Clinical Medicine, Qingdao University, Qingdao, China
| | - Jian Zhou
- West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Hai-Chen Chu
- School of Clinical Medicine, Qingdao University, Qingdao, China
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Stengel D, Spranger N, Wirth S, Schmittner M. Spinalanästhesie vs. Allgemeinnarkose bei operativer Stabilisierung hüftgelenknaher Femurfrakturen. Unfallchirurg 2022; 125:336-338. [DOI: 10.1007/s00113-022-01146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
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Liu S, Xv L, Wu X, Wang F, Wang J, Tang X, Dong R, Wang B, Lin X, Bi Y. Potential value of preoperative fasting blood glucose levels in the identification of postoperative delirium in non-diabetic older patients undergoing total hip replacement: The perioperative neurocognitive disorder and biomarker lifestyle study. Front Psychiatry 2022; 13:941048. [PMID: 36311514 PMCID: PMC9606582 DOI: 10.3389/fpsyt.2022.941048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common complication after total hip replacement. This study aims to explore the relationship between preoperative fasting blood glucose (FBG) levels and POD in non-diabetic older patients undergoing total hip replacement. MATERIALS AND METHODS This study included a total of 625 patients undergoing elective total hip replacement under combined spinal and epidural anesthesia from the PNDABLE study. The relationship between POD and preoperative FBG was analyzed by using the logistic regression model. The associations of FBG with individual cerebrospinal fluid (CSF) biomarkers were detected by using the multivariable linear regression model controlling for age, gender, and education level. The mediation effects were explored by mediation analyses with 5,000 bootstrap iterations, while sensitivity analysis was used to test the reliability and stability of the results. The receiver operating characteristic (ROC) curve and the nomogram model were applied to evaluate the efficacy of FBG and POD-related CSF biomarkers in predicting POD. POD assessment was performed two times daily by a trained anesthesiologist at 9:00-10:00 am and 2:00-3:00 pm on postoperative days 1-7 or before the patients were discharged from the hospital. POD was defined by the Confusion Assessment Method (CAM), and POD severity was measured using the Memorial Delirium Assessment Scale (MDAS). Enzyme-linked immunosorbent assay (ELISA) was used to measure CSF Aβ40, Aβ42, T-tau, and P-tau levels. RESULTS POD was detected in 10.2% (60/588) of the patients. Logistic regression analysis showed that after adjusting for age and education level, the increased levels of FBG (OR 1.427, 95% CI 1.117-1.824, P = 0.004), CSF P-tau (OR 1.039, 95% CI 1.019-1.060, P < 0.001), and CSF T-tau (OR 1.013, 95% CI 1.009-1.018, P < 0.001) were risk factors for POD, and the increased level of CSF Aβ42 (OR 0.996, 95% CI 0.994-0.998, P = 0.001) was a protective factor for POD. Multivariable linear regression models showed that when adjusting for age, gender, and education level, in the POD group, higher preoperative FBG levels were negatively correlated with the CSF Aβ42 level (β = -0.290, P = 0.028) and positively correlated with CSF P-tau (β = 0.384, P = 0.004) and T-tau (β = 0.447, P < 0.001). In the non-POD group, a higher preoperative FBG was not related to CSF biomarkers. Mediated effect analysis showed that CSF T-tau (proportion = 17.1%) had an apparent mediation effect on the relationship between FBG and POD. Sensitivity analysis revealed that the results from the logistic regression and multivariable linear regression models were consistent with previous results. CONCLUSION Increased preoperative FBG was a risk factor for POD in older patients without T2DM, and T-tau might mediate the relationship between FBG and POD.
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Affiliation(s)
- Siyu Liu
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Lizhu Xv
- Medical Department, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Xiaoyue Wu
- Department of Anesthesiology, Dalian Medical University, Dalian, Liaoning, China
| | - Fei Wang
- Department of Anesthesiology, Nanjing Medical University, Nanjing, China
| | - Jiahan Wang
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Xinhui Tang
- Department of Anesthesiology, Dalian Medical University, Dalian, Liaoning, China
| | - Rui Dong
- Department of Anesthesiology, Gulou Hospital Affiliated to Medical College of Nanjing University, Nanjing, China
| | - Bin Wang
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Xu Lin
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Yanlin Bi
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
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Ahn J, Chang JS, Kim JW. Postoperative Pneumonia and Aspiration Pneumonia Following Elderly Hip Fractures. J Nutr Health Aging 2022; 26:732-738. [PMID: 35842764 DOI: 10.1007/s12603-022-1821-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The present study aimed to investigate the incidence of and risk factors for postoperative pneumonia and aspiration pneumonia after hip fracture surgery. DESIGN Retrospective cohort study from 2005 to 2021. SETTING Asan Medical Center in Seoul, Republic of Korea. PARTICIPANTS A total 1,208 patients aged ≥ 65 years who underwent hip fracture surgery. MEASUREMENTS Postoperative pneumonia was defined as cases with new infiltration on chest x-ray or chest computed tomography (CT) after surgery or confirmed by a pulmonologist's consultation and diagnosis. Aspiration pneumonia was defined as: 1) radiologic findings of hospital-acquired pneumonia on chest radiographs or CT, medical record of aspiration pneumonia confirmed by a pulmonologist's consultation, and history of vomiting or aspiration, or 2) gravity-dependent opacity on chest CT when the history of vomiting or aspiration is ambiguous. Patient demographics, past medical history, pre-injury Koval score, Charlson Comorbidity Index (CCI), blood test results, length of hospital stay, and in-hospital mortality were evaluated. A comparison analysis and binary logistic regression were performed to identify the incidence and risk factors for postoperative pneumonia and aspiration pneumonia. RESULTS Postoperative pneumonia was diagnosed in 47 patients (3.9%), including 20 with aspiration pneumonia (1.7%). In the multivariate analysis, postoperative delirium (odds ratio [OR], 3.42; P < 0.001), American Society of Anesthesiologists (ASA) scores ≥ 3 (OR, 2.11; P = 0.021), and CCI (OR, 1.21; P = 0.013) were significant risk factors for postoperative pneumonia. Male sex (OR, 3.01; P = 0.017), postoperative delirium (OR, 3.16; P = 0.014), and preoperative serum albumin levels < 3.5 g/dL (OR, 7.00; P = 0.010) were significant risk factors for aspiration pneumonia. CONCLUSION ASA classification ≥ 3, higher CCI, and postoperative delirium were the risk factors for postoperative pneumonia. Male sex, postoperative delirium, and lower preoperative serum albumin level were the risk factors for aspiration pneumonia. Thus, physicians should pay attention to patients with the risk factors.
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Affiliation(s)
- J Ahn
- Ji Wan Kim, Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea, Phone: +82-2-3010-3530, Fax: +82-2-2045-4542, Email address: , ORCID: 0000-0002-3524-8706
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Risk Factors and a Nomogram Model Establishment for Postoperative Delirium in Elderly Patients Undergoing Arthroplasty Surgery: A Single-Center Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6607386. [PMID: 34901277 PMCID: PMC8660191 DOI: 10.1155/2021/6607386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022]
Abstract
Objective To explore the related risk factors of postoperative delirium (POD) after hip or knee arthroplasty in elderly orthopedic patients and the predictive value of related risk factors. Material and Methods. In total, 309 patients (≥60 years) who received knee and hip arthroplasty between January 2017 and May 2020 were consecutively selected into the POD and nonpostoperative delirium (NPOD) groups. Group bias was eliminated through propensity score matching. Univariate and multivariable logistic analysis was used to determine the risk factors for POD. The nomogram was made by R. Results 58 patients were included in each group after propensity score matching; multivariable analysis demonstrated that LDH (OR = 4.364, P = 0.017), CHE (OR = 4.640, P = 0.004), Cystatin C (OR = 5.283, P = 0.006), arrhythmia (OR = 5.253, P = 0.002), and operation duration (OR = 1.017, P = 0.050) were independent risk factors of POD. LDH, CHE, Cystatin C, and arrhythmia were used to construct a nomogram to predict the POD. The nomogram was well calibrated and had moderate discriminative ability (AUC = 0.821, 95% CI: 0.760~0.883). Decision curve analysis demonstrated that the nomogram was clinically useful. Conclusions Our study revealed that arrhythmia, operation duration, the increase of lactate dehydrogenase and Cystatin C, and the decrease of cholinesterase were reliable factors for predicting postoperative delirium after elderly hip and knee arthroplasty. Meanwhile, the nomogram we developed can assist the clinician to filtrate potential patients with postoperative delirium.
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Liu B, Huang D, Guo Y, Sun X, Chen C, Zhai X, Jin X, Zhu H, Li P, Yu W. Recent advances and perspectives of postoperative neurological disorders in the elderly surgical patients. CNS Neurosci Ther 2021; 28:470-483. [PMID: 34862758 PMCID: PMC8928923 DOI: 10.1111/cns.13763] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 12/17/2022] Open
Abstract
Postoperative neurological disorders, including postoperative delirium (POD), postoperative cognitive dysfunction (POCD), postoperative covert ischemic stroke, and hemorrhagic stroke, are challenging clinical problems in the emerging aged surgical population. These disorders can deteriorate functional outcomes and long‐term quality of life after surgery, resulting in a substantial social and financial burden to the family and society. Understanding predisposing and precipitating factors may promote individualized preventive treatment for each disorder, as several risk factors are modifiable. Besides prevention, timely identification and treatment of etiologies and symptoms can contribute to better recovery from postoperative neurological disorders and lower risk of long‐term cognitive impairment, disability, and even death. Herein, we summarize the diagnosis, risk factors, prevention, and treatment of these postoperative complications, with emphasis on recent advances and perspectives.
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Affiliation(s)
- Biying Liu
- Department of Anesthesiology, State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Dan Huang
- Department of Anesthesiology, State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Yunlu Guo
- Department of Anesthesiology, State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoqiong Sun
- Department of Anesthesiology, State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Caiyang Chen
- Department of Anesthesiology, State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Xiaozhu Zhai
- Department of Anesthesiology, State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Xia Jin
- Department of Anesthesiology, State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Hui Zhu
- Department of Anesthesiology, State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Peiying Li
- Department of Anesthesiology, State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Weifeng Yu
- Department of Anesthesiology, State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
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Bhushan S, Li Y, Huang X, Cheng H, Gao K, Xiao Z. Progress of research in postoperative cognitive dysfunction in cardiac surgery patients: A review article. Int J Surg 2021; 95:106163. [PMID: 34743049 DOI: 10.1016/j.ijsu.2021.106163] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) is a common complication of central nervous system in middle-aged and elderly patients after cardiac surgery. The purpose of this study was to review the progress in diagnosis, pathogenesis and risk factors and control strategy of POCD. METHODS A systematic literature search was conducted using Pubmed and EMBASE, using the Mesh terms and key words "POCD", "diagnostic criteria", "pathogenesis", "influencing factors" and "prevention strategies". Studies were retained for review after meeting strict inclusion criteria that included only prospective studies evaluating risk factors for POCD in patients who had elective cardiac surgery. Diagnosis of POCD needed to be confirmed using the Diagnostic and Statistical Manual of Montreal Cognitive Assessment (MoCA) Scale and other criteria. RESULTS "Twenty two articles were selected for inclusion. The incidence of POCD across the studies ranged from 9% to 54%. Multiple factors have been associated with the pathogenesis and increased risk of POCD, including neuroinflammation, dysfunction of cholinergic system, abnormal protein function (β-amyloid), old age, anesthetic, surgical and other factors." CONCLUSIONS POCD is a common complication after cardiac surgery in elderly. The highest POCD incidence was observed after open aortic, TAVI and CABG surgery. Age, cognitive function, depression, CPB and anesthetic use are leading risk factors. Further research is needed in determining interventions that will be effective in preventing and treating POCD in cardiac surgical setting.
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Affiliation(s)
- Sandeep Bhushan
- Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China Department of Anesthesiology, West China Hospital of Medicine, Sichuan University, Sichuan, 610017, China
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Bhushan S, Li Y, Huang X, Cheng H, Gao K, Xiao Z. Progress of research in postoperative cognitive dysfunction in cardiac surgery patients: A review article. Int J Surg 2021. [DOI: https://doi.org/10.1016/j.ijsu.2021.106163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Saxena S, Kruys V, De Jongh R, Vamecq J, Maze M. High-Mobility Group Box-1 and Its Potential Role in Perioperative Neurocognitive Disorders. Cells 2021; 10:2582. [PMID: 34685561 PMCID: PMC8533835 DOI: 10.3390/cells10102582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/12/2022] Open
Abstract
Aseptic surgical trauma provokes the release of HMGB1, which engages the innate immune response after binding to pattern-recognition receptors on circulating bone marrow-derived monocytes (BM-DM). The initial systemic inflammation, together with HMGB1, disrupts the blood-brain barrier allowing penetration of CCR2-expressing BM-DMs into the hippocampus, attracted by the chemokine MCP-1 that is upregulated by HMGB1. Within the brain parenchyma quiescent microglia are activated and, together with the translocated BM-DMs, release proinflammatory cytokines that disrupt synaptic plasticity and hence memory formation and retention, resulting in postoperative cognitive decline (PCD). Neutralizing antibodies to HMGB1 prevents the inflammatory response to trauma and PCD.
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Affiliation(s)
- Sarah Saxena
- Department of Anesthesia, University Hospital Center (CHU de Charleroi), 6000 Charleroi, Belgium;
| | - Véronique Kruys
- ULB Immunology Research Center (UIRC), Laboratory of Molecular Biology of the Gene, Department of Molecular Biology, Free University of Brussels (ULB), 6041 Gosselies, Belgium;
| | - Raf De Jongh
- Department of Anesthesia, Fondation Hopale, 62600 Berck-sur-Mer, France;
| | - Joseph Vamecq
- Inserm, CHU Lille, Université de Lille, CHRU Lille, Center of Biology and Pathology (CBP) Pierre-Marie Degand, EA 7364 RADEME, 59000 Lille, France;
- Laboratory of Hormonology, Metabolism-Nutrition & Oncology (HMNO), Department of Biochemistry and Molecular Biology, University of North France, 59000 Lille, France
| | - Mervyn Maze
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA 94143, USA
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Lee SY, Lee H, Lee JS, Han SA, Kim YJ, Kim JY, Tchah H. Association between glaucoma surgery and all-cause and cause-specific mortality among elderly patients with glaucoma: a nationwide population-based cohort study. Sci Rep 2021; 11:17055. [PMID: 34426612 PMCID: PMC8382742 DOI: 10.1038/s41598-021-96063-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/20/2021] [Indexed: 11/21/2022] Open
Abstract
This population-based, retrospective cohort study aimed to evaluate the association between glaucoma surgery and all-cause and cause-specific mortality among Korean elderly patients with glaucoma. A total of 16210 elderly patients (aged ≥ 60 years) diagnosed with glaucoma between 2003 and 2012 were included, and their insurance data were analyzed. The participants were categorized into a glaucoma surgery cohort (n = 487), which included individuals who had diagnostic codes for open angle glaucoma (OAG) or angle closure glaucoma (ACG) and codes for glaucoma surgery, and a glaucoma diagnosis cohort (n = 15,723), which included patients who had codes for OAG and ACG but not for glaucoma surgery. Sociodemographic factors, Charlson Comorbidity Index score, and ocular comorbidities were included as covariates. Cox regression models were used to assess the association between glaucoma surgery and mortality. The incidence of all-cause mortality was 34.76/1,000 person-years and 27.88/1,000 person-years in the glaucoma surgery and diagnosis groups, respectively. The adjusted hazard ratio (HR) for all-cause mortality associated with glaucoma surgery was 1.31 (95% confidence interval [CI], 1.05–1.62, P = 0.014). The adjusted HR for mortality due to a neurologic cause was significant (HR = 2.66, 95% CI 1.18–6.00, P = 0.018). The adjusted HRs for mortality due to cancer (HR = 2.03, 95% CI 1.07–3.83, P = 0.029) and accident or trauma (HR = 4.00, 95% CI 1.55–10.34, P = 0.004) associated with glaucoma surgery for ACG were significant as well. Glaucoma surgery was associated with an increase of mortality in elderly patients with glaucoma. In particular, the risk of mortality associated with glaucoma surgery due to neurologic causes was significant.
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Affiliation(s)
- Sang Yeop Lee
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Korea.,Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sol Ah Han
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Yoon Jeon Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
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Unal N, Guvenc G, Ilkin Naharci M. Evaluation of the effectiveness of delirium prevention care protocol for the patients with hip fracture: A randomised controlled study. J Clin Nurs 2021; 31:1082-1094. [PMID: 34302312 DOI: 10.1111/jocn.15973] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 01/09/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to investigate the effectiveness of a delirium prevention care protocol on pain, functional status, sleep quality and delirium prevention in patients with hip fractures. BACKGROUND The development of delirium following hip fracture is common among older patients. According to the National Institute for Health and Care Excellence, 30% of delirium cases are preventable. The prevention of delirium, a multifactorial syndrome, can be achieved through a multicomponent care protocol that targets specific risk factors for delirium. DESIGN A randomised controlled study was conducted according to the CONSORT 2010 guidelines. The Clinical Trial Registry number is NCT04188795. METHODS A total of 84 patients were assigned to two groups by block randomisation. The intervention group (n = 41) received nursing care according to a protocol and the control group (n = 43) received standard nursing care. Study data were collected using the demographic information form, the Confusion Assessment Method-Intensive Care Unit (CAM-ICU), the Barthel Index, the Mini Nutritional Assessment-short form and the Richards-Campbell Sleep Questionnaire (RCSQ). The pain of the patients was assessed by using a Visual Analog Scale (VAS). RESULTS The mean age of the patients was 80.6 years (standard deviation 8.0; range 65.0- 97.5 years), and the percentage of the male patients were 36.3%. No statistically significant differences were found between the groups in terms of pain and functional status in the preoperative period, on the first postoperative day, or in the predischarge period (p > 0.05 for each). The sleep quality of patients in the intervention group was significantly better than in the control group for all three time measurements (p < 0.05 for each). While 15% of patients in the control group developed delirium, no patient in the intervention group developed delirium (x2 =6.486, p = 0.026). CONCLUSION This study demonstrated that a delirium prevention care protocol may reduce the incidence of delirium and improve sleep quality. RELEVANCE TO PRACTICE The study highlighted that nurses can contribute to preventing patients' delirium using nonpharmacologic and independent nursing interventions.
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Affiliation(s)
- Nursemin Unal
- Faculty of Health Sciences, School of Nursing, Ankara Medipol University, Ankara, Turkey
| | - Gulten Guvenc
- Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
| | - Mehmet Ilkin Naharci
- Geriatrics Department, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Ocagli H, Bottigliengo D, Lorenzoni G, Azzolina D, Acar AS, Sorgato S, Stivanello L, Degan M, Gregori D. A Machine Learning Approach for Investigating Delirium as a Multifactorial Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137105. [PMID: 34281037 PMCID: PMC8297073 DOI: 10.3390/ijerph18137105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/12/2022]
Abstract
Delirium is a psycho-organic syndrome common in hospitalized patients, especially the elderly, and is associated with poor clinical outcomes. This study aims to identify the predictors that are mostly associated with the risk of delirium episodes using a machine learning technique (MLT). A random forest (RF) algorithm was used to evaluate the association between the subject’s characteristics and the 4AT (the 4 A’s test) score screening tool for delirium. RF algorithm was implemented using information based on demographic characteristics, comorbidities, drugs and procedures. Of the 78 patients enrolled in the study, 49 (63%) were at risk for delirium, 32 (41%) had at least one episode of delirium during the hospitalization (38% in orthopedics and 31% both in internal medicine and in the geriatric ward). The model explained 75.8% of the variability of the 4AT score with a root mean squared error of 3.29. Higher age, the presence of dementia, physical restraint, diabetes and a lower degree are the variables associated with an increase of the 4AT score. Random forest is a valid method for investigating the patients’ characteristics associated with delirium onset also in small case-series. The use of this model may allow for early detection of delirium onset to plan the proper adjustment in healthcare assistance.
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Affiliation(s)
- Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (D.B.); (G.L.); (D.A.)
| | - Daniele Bottigliengo
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (D.B.); (G.L.); (D.A.)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (D.B.); (G.L.); (D.A.)
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (D.B.); (G.L.); (D.A.)
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64B, 44121 Ferrara, Italy
| | - Aslihan S. Acar
- Department of Actuarial Sciences, Hacettepe University, Ankara 06800, Turkey;
| | - Silvia Sorgato
- Health Professional Management Service (DPS) of the University Hospital of Padova, 35128 Padova, Italy; (S.S.); (L.S.); (M.D.)
| | - Lucia Stivanello
- Health Professional Management Service (DPS) of the University Hospital of Padova, 35128 Padova, Italy; (S.S.); (L.S.); (M.D.)
| | - Mario Degan
- Health Professional Management Service (DPS) of the University Hospital of Padova, 35128 Padova, Italy; (S.S.); (L.S.); (M.D.)
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Loredan 18, 35121 Padova, Italy; (H.O.); (D.B.); (G.L.); (D.A.)
- Correspondence: ; Tel.: +39-049-827-5384
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Costa-Martins I, Carreteiro J, Santos A, Costa-Martins M, Artilheiro V, Duque S, Campos L, Chedas M. Post-operative delirium in older hip fracture patients: a new onset or was it already there? Eur Geriatr Med 2021; 12:777-785. [PMID: 33569717 DOI: 10.1007/s41999-021-00456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Hip fractures are a worldwide health issue primarily for older patients, conditioning major morbidity and mortality. An experienced multidisciplinary team is essential to manage surgery and peri-operative implications, to enable rapid functional and cognitive recovery. Delirium is a recognizable problem associated with negative outcomes. Our study aims to determine the influence of pre-operative delirium in the incidence of post-operative delirium, and to evaluate the association between other known peri-operative risk factors with both conditions. METHODS A single-center, retrospective cohort study, conducted at a Level II trauma center over a 14-month period, included 241 patients with 65 years of age or older submitted to hip fracture surgery. Peri-operative data were gathered regarding baseline characteristics (sociodemographic, functional and cognitive status), intra-operative events (anesthesia technique, surgery duration, blood loss) and post-operative outcomes (delirium occurrence). RESULTS Statistical analysis evidenced a female (75.5%) and elderly population (83.9 ± 7.8 years old) with significant comorbidities (cognitive impairment in 51.9%, ASA ≥ III in 79.7%, mean CIRS-G 8.83 ± 4.69) that underwent surgical fracture repair, mostly under 4 h (96.3%) and under regional anesthesia (63.1%). Pre- and post-operative delirium incidence was 18.3% and 12.9%, respectively, displaying increased presence according to cognitive impairment severity. CONCLUSION Post-operative delirium was almost inexistent when it was absent pre-operatively. Moreover, pre-operative cognitive status was associated with the development of pre- and post-operative delirium. Careful cognitive assessment, implementation of preventive strategies and avoidance of peri-operative pro-delirium factors are crucial for comprehensive geriatric care.
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Affiliation(s)
- Isabel Costa-Martins
- Anaesthesiology Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal.
| | - Joana Carreteiro
- Anaesthesiology Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Ana Santos
- Internal Medicine Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Mariana Costa-Martins
- Clinical Psychologist, Rua Major Neutel de Abreu, nr 13, 10° A, 1500-409, Lisbon, Portugal
| | - Vanessa Artilheiro
- Anaesthesiology Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Sofia Duque
- Orthogeriatric Unit, Internal Medicine Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Luís Campos
- Internal Medicine Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
| | - Manuel Chedas
- Anaesthesiology Department, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005, Lisbon, Portugal
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