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Park CH, Lee SH, Lee R, Kim DY, Cho MR, Song SK. Effects of body mass index on mortality in elderly patients with hip fractures. Medicine (Baltimore) 2024; 103:e39157. [PMID: 39093801 PMCID: PMC11296480 DOI: 10.1097/md.0000000000039157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024] Open
Abstract
Hip fractures remain a substantial health concern, particularly among elderly individuals with osteoporosis, leading to high global mortality rates. This study aimed to analyze the association between body mass index (BMI) and postoperative mortality in patients who underwent surgery for hip fractures. A total of 680 patients treated at a single institution between January 2018 and December 2022 were included. Factors such as age, BMI, sex, Charlson Comorbidity Index (CCI), preoperative hemoglobin levels, American Society of Anesthesiologists score, anesthesia method, duration of surgery, and time from injury to surgery were assessed. Underweight status, male sex, higher CCI, and general anesthesia were significantly associated with 1-year and in-hospital mortality. Notably, underweight individuals exhibited a higher risk of mortality than normal-weight individuals, and female patients had lower mortality rates. This study underscores the importance of considering BMI, along with other demographic and clinical factors, in predicting postoperative mortality among patients with hip fractures, aiding the development of tailored management strategies to improve outcomes and reduce complications in this vulnerable patient population.
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Affiliation(s)
- Chan-Hee Park
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Republic of Korea
| | - Seung-Hoon Lee
- School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Rim Lee
- School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Dong-Young Kim
- Department of Orthopaedic Surgery, Gumi Hyundai Hospital, Gumi, Republic of Korea
| | - Myung-Rae Cho
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Suk-Kyoon Song
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea
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Lu Z, Wang B, Liu M, Yu D, Li J. Correlation analysis between plasma biomarkers albumin, fibrinogen, and their ratio with postoperative delirium in patients undergoing non-cardiac surgery: a systematic review and meta-analysis. Am J Transl Res 2024; 16:363-373. [PMID: 38463596 PMCID: PMC10918125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/23/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVES This meta-analysis aimed to investigate the correlation between plasma biomarkers, such as albumin and fibrinogen, and their ratio with postoperative delirium (POD) in patients undergoing non-cardiac surgery. METHODS Relevant observational cohort studies were systematically searched in PubMed, EMBASE, CINAHL, and the Cochrane Library databases as of March 2023. This meta-analysis was conducted using RevMan 5.4.1 and Stata 15.0 software. For continuous variables with non-uniform units, the standardized mean difference (SMD) and 95% confidence intervals (CIs) were used; otherwise, the mean difference (MD) and 95% CIs were employed. The Newcastle-Ottawa Scale (NOS) was applied to assess the quality of included literature. RESULTS Eighteen studies encompassing 7,011 patients were included. The meta-analysis revealed significantly lower albumin levels (sixteen studies, 5,813 patients, SMD = -0.45, 95% CI = -0.64 to -0.26, P < 0.00001, I2 = 80%) and albumin-fibrinogen ratio (AFR) (four studies, 824 patients, MD = -0.62, 95% CI = -0.76 to -0.48, P = 0.56, I2 = 0%) in the delirious group. Conversely, higher fibrinogen concentrations (two studies, 441 patients, MD = 0.13, 95% CI = 0.02 to 0.24, P = 0.69, I2 = 0%) were observed in the delirious group. Due to high heterogeneity in albumin levels (P < 0.00001, I2 = 80%), we conducted a subgroup and sensitivity analysis, and confirmed that the association of albumin levels was not influenced by surgery type, design or delirium evaluation instruments. CONCLUSIONS Preoperative albumin, fibrinogen and AFR levels were associated with POD, potentially aiding in identifying high-risk patients and playing a key role in preventing POD.
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Affiliation(s)
- Zhenhui Lu
- Department of Anesthesiology, Hebei General HospitalShijiazhuang 050051, Hebei, China
| | - Bei Wang
- Department of Gynaecology, Hebei General HospitalShijiazhuang 050051, Hebei, China
| | - Meinv Liu
- Department of Anesthesiology, Hebei General HospitalShijiazhuang 050051, Hebei, China
| | - Dongdong Yu
- Department of Anesthesiology, Hebei General HospitalShijiazhuang 050051, Hebei, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General HospitalShijiazhuang 050051, Hebei, China
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Wang W, Yao W, Tang W, Li Y, Lv Q, Ding W. Association between preoperative albumin levels and postoperative delirium in geriatric hip fracture patients. Front Med (Lausanne) 2024; 11:1344904. [PMID: 38420358 PMCID: PMC10899384 DOI: 10.3389/fmed.2024.1344904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Objective This study aims to examine the association between preoperative serum albumin levels and postoperative delirium (POD) in geriatric patients who have undergone hip fracture surgery, with the goal of offering novel insights for clinical interventions targeting POD. Methods A retrospective analysis was conducted on the medical records of patients who underwent hip fracture surgery in a tertiary medical institution from January 2013 to November 2023. The patients were classified based on hypoalbuminemia (defined as a serum albumin level < 35 g/L) and clinical threshold. Multivariable logistic regression and propensity score matching analysis (PSM) were employed to calculate the adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for POD to eliminate potential confounding factors. Additionally, subgroup analysis was performed to explore the interaction effect. Results The retrospective cohort study included 1,440 patients, with an incidence of POD found to be 19.1%. In a multivariable logistic regression analysis, patients with hypoalbuminemia had an adjusted OR of 2.99 (95%CI: 2.14-4.18) compared to those with normal albumin levels (≥ 35 g/L). Furthermore, a significant trend was observed across different severity categories, including mild hypoalbuminemia (34.9-30.0 g/L; adjusted OR = 2.71, 95%CI: 1.84-3.99), moderate hypoalbuminemia (29.9-25.0 g/L, adjusted OR = 3.44, 95%CI: 1.88-6.28), and severe hypoalbuminemia (<25.0 g/L; adjusted OR = 3.97, 95%CI: 1.78-8.86), with a trend value of p <0.001. Similar results were observed in the PSM analysis. Additionally, treating preoperative serum albumin level as a continuous variable, the risk of POD increased by 11% (95% CI, 1.08-1.15) with each 1 g/L decrease in preoperative serum albumin level. Conclusion Low preoperative levels of albumin are strongly associated with POD in geriatric patients with hip fractures, and a significant dose-response relationship exists between them.
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Affiliation(s)
- Wei Wang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wei Yao
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wanyun Tang
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Yuhao Li
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
| | - Qiaomei Lv
- Department of Oncology, Dandong Central Hospital, China Medical University, Dandong, China
| | - Wenbo Ding
- Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China
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Lim C, Roh YH, Park YG, Lee J, Nam KW. Is there a difference between preoperative and postoperative delirium in elderly hip fracture patients?: A retrospective case control study. Medicine (Baltimore) 2024; 103:e36584. [PMID: 38277519 PMCID: PMC10817095 DOI: 10.1097/md.0000000000036584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/20/2023] [Indexed: 01/28/2024] Open
Abstract
Delirium is associated with greater morbidity, higher mortality, and longer periods of hospital day after hip fracture. There are number of studies on postoperative delirium after a hip fracture. However, few studies have made a distinction between preoperative and postoperative delirium. The purpose of this study is to compare risk factors and clinical outcome between preoperative and postoperative delirium in elderly patients with a hip fracture surgery. A total of 382 consecutive patients aged > 65 years who underwent operation for hip fracture were enrolled. Among them, the patients diagnosed with delirium were divided into 2 groups (a preoperative delirium group and a postoperative delirium group) according to the onset time of delirium. To evaluate risk factors for preoperative and postoperative delirium, we analyzed demographic data, preoperative laboratory data, and perioperative data. To compare clinical outcomes between preoperative and postoperative delirium, we analyzed postoperative complications, KOVAL score, regression, readmission, and 2-year survival rate. Delirium was diagnosed in 150 (39.3%) patients during hospitalization. Preoperative and postoperative delirium occurred in 67 (44.6%) and 83 (55.4%) patients, respectively. Independent risk factors of preoperative delirium included age (odds ratio: 1.47, 95% confidential interval [CI]: 1.13-2.23, P = .004), stroke (odds ratio [OR]: 2.70, 95% CI: 1.11-6.01, P = .015), American Society of Anesthesiologist (OR: 1.68, 95% CI: 1.137-2.24, P = .033), and time from admission to operation (OR: 1.08, 95% CI: 1.01-1.16, P = .031). There was no significant difference in preoperative KOVAL score between the 2 groups. However, postoperative KOVAL score (5.1 ± 2.0 vs 4.4 ± 2.1, P = .027) and regression rate (68.7% vs 44.6%, P = .029) were significantly higher in the preoperative delirium group than in the postoperative delirium group. Moreover, the 2-year survival rate was significantly lower in the preoperative delirium group than in the postoperative delirium group (62.7% vs 78.3%, P = .046). Characteristics, risk factors, and prognosis are different for patients with preoperative delirium and postoperative delirium. Preoperative delirium patients showed different risk factors with poorer prognosis and higher mortality. Therefore, hip fracture patients with risk factors for preoperative delirium should be monitored more carefully due to their greater risk of mortality.
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Affiliation(s)
- Chaemoon Lim
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Korea
| | - Young Ho Roh
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Korea
| | - Yong-Geun Park
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Korea
| | - Jaeryun Lee
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Korea
| | - Kwang Woo Nam
- Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu-si, Gyeonggi-do, Korea
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Callan KT, Donnelly M, Lung B, McLellan M, DiGiovanni R, McMaster W, Yang S, Stitzlein R. Risk factors for postoperative delirium in orthopaedic hip surgery patients: a database review. BMC Musculoskelet Disord 2024; 25:71. [PMID: 38233831 PMCID: PMC10792907 DOI: 10.1186/s12891-024-07174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/05/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Postoperative delirium is a common problem affecting admitted patients that decreases patient satisfaction and increases the cost and complexity of care. The purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to compare rates and risk factors of postoperative delirium for total hip arthroplasty (THA) and hemiarthroplasty patients indicated for osteoarthritis or proximal femur fracture. METHODS The 2021 NSQIP database was queried for patients using Current Procedural Terminology (CPT) codes for THA and hemiarthroplasty and ICD-10 codes for osteoarthritis or proximal femur fracture. Demographic, past medical history, preoperative labs, and functional status data were recorded. Procedural data were also collected. Finally, postoperative outcomes and complications were reviewed. RESULTS Overall, 16% of patients had postoperative delirium. Delirium patients were older on average (82.4 years vs. 80.7 years, p < 0.001), had a lower BMI (19.5 vs. 24.8, p < 0.001), were more likely to have a history of dementia (54.6% vs. 13.6%, p < 0.001), were less likely to have an independent functional status (p < 0.001) or live alone (p < 0.001), and were more likely to have sustained a recent fall (p < 0.001). Delirium patients were more likely to be hyponatremic or hypernatremic (p = 0.002), anemic (p < 0.001), and severely dehydrated (p < 0.001), among other lab abnormalities. Delirium patients were also more likely to experience additional postoperative complications, including pneumonia, pulmonary embolism, urinary tract infection, stroke, cardiac arrest, sepsis, and unplanned reoperation and readmission after discharge (all p < 0.05). CONCLUSIONS In this study, factors associated with postoperative delirium in patients undergoing hemiarthroplasty and THA were identified, including older age, lower BMI, certain medical conditions, decreased functional status, certain lab abnormalities, and postoperative complications. These findings can be used by clinicians to better inform care and to determine when orthopaedic joint replacement patients may be at an increased risk for postoperative delirium.
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Affiliation(s)
- Kylie T Callan
- University of California Irvine School of Medicine, Irvine, CA, USA.
| | - Megan Donnelly
- New York University Langone Medical Center, New York, NY, USA
| | - Brandon Lung
- University of California Irvine Health, Orange, CA, USA
| | | | | | | | - Steven Yang
- University of California Irvine Health, Orange, CA, USA
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Piccirillo A, Perri F, Vittori A, Ionna F, Sabbatino F, Ottaiano A, Cascella M. Evaluating Nutritional Risk Factors for Delirium in Intensive-Care-Unit Patients: Present Insights and Prospects for Future Research. Clin Pract 2023; 13:1577-1592. [PMID: 38131687 PMCID: PMC10742123 DOI: 10.3390/clinpract13060138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Malnutrition, hypercatabolism, and metabolic changes are well-established risk factors for delirium in critically ill patients. Although the exact mechanisms are not fully understood, there is mounting evidence suggesting that malnutrition can cause a variety of changes that contribute to delirium, such as electrolyte imbalances, immune dysfunction, and alterations in drug metabolism. Therefore, a comprehensive metabolic and malnutrition assessment, along with appropriate nutritional support, may help to prevent or ameliorate malnutrition, reduce hypercatabolism, and improve overall physiological function, ultimately lowering the risk of delirium. For this aim, bioelectrical impedance analysis can represent a valuable strategy. Further research into the underlying mechanisms and nutritional risk factors for delirium is crucial to developing more effective prevention strategies. Understanding these processes will allow clinicians to personalize treatment plans for individual patients, leading to improved outcomes and quality of life in the intensive-care-unit survivors.
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Affiliation(s)
- Arianna Piccirillo
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Francesco Perri
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Franco Ionna
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | | | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Abdominal Oncology, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, 80131 Naples, Italy;
| | - Marco Cascella
- Unit of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Department of Medicine, Surgery, and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081 Baronissi, Italy
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Gong XY, Hou DJ, Yang J, He JL, Cai MJ, Wang W, Lu XY, Gao J. Incidence of delirium after non-cardiac surgery in the Chinese elderly population: a systematic review and meta-analysis. Front Aging Neurosci 2023; 15:1188967. [PMID: 37455941 PMCID: PMC10346854 DOI: 10.3389/fnagi.2023.1188967] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background POD places a heavy burden on the healthcare system as the number of elderly people undergoing surgery is increasing annually because of the aging population. As a large country with a severely aging population, China's elderly population has reached 267 million. There has been no summary analysis of the pooled incidence of POD in the elderly Chinese population. Methods Systematic search databases included PubMed, Web of Science, EMBASE, Cochrane Library Databases, China Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Database (CBM), WanFang Database, and Chinese Science and Technology Periodicals (VIP). The retrieval time ranged from the database's establishment to February 8, 2023. The pooled incidence of delirium after non-cardiac surgery was calculated using a random effects model. Meta-regression, subgroup, and sensitivity analyses were used to explore the source of heterogeneity. Results A total of 52 studies met the inclusion criteria, involving 18,410 participants. The pooled incidence of delirium after non-cardiac surgery in the elderly Chinese population was 18.6% (95% CI: 16.4-20.8%). The meta-regression results revealed anesthesia method and year of publication as a source of heterogeneity. In the subgroup analysis, the gender subgroup revealed a POD incidence of 19.6% (95% CI: 16.9-22.3%) in males and 18.3% (95% CI: 15.7-20.9%) in females. The year of publication subgroup analysis revealed a POD incidence of 20.3% (95% CI: 17.4-23.3%) after 2018 and 14.6 (95% CI: 11.6-17.6%) in 2018 and before. In the subgroup of surgical types, the incidence of hip fracture surgery POD was 20.7% (95% CI: 17.6-24.3%), the incidence of non-cardiac surgery POD was 18.4% (95% CI: 11.8-25.1%), the incidence of orthopedic surgery POD was 16.6% (95% CI: 11.8-21.5%), the incidence of abdominal neoplasms surgery POD was 14.3% (95% CI: 7.6-21.1%); the incidence of abdominal surgery POD was 13.9% (95% CI: 6.4-21.4%). The anesthesia methods subgroup revealed a POD incidence of 21.5% (95% CI: 17.9-25.1%) for general anesthesia, 15.0% (95% CI: 10.6-19.3%) for intraspinal anesthesia, and 8.3% (95% CI: 10.6-19.3%) for regional anesthesia. The measurement tool subgroup revealed a POD incidence of 19.3% (95% CI: 16.7-21.9%) with CAM and 16.8% (95% CI: 12.6-21.0%) with DSM. The sample size subgroup revealed a POD incidence of 19.4% (95% CI: 16.8-22.1%) for patients ≤ 500 and 15.3% (95% CI: 11.0-19.7%) for patients > 500. The sensitivity analysis suggested that the pooled incidence of postoperative delirium in this study was stable. Conclusion Our systematic review of the incidence of delirium after non-cardiac surgery in elderly Chinese patients revealed a high incidence of postoperative delirium. Except for cardiac surgery, the incidence of postoperative delirium was higher for hip fracture surgery than for other types of surgery. However, this finding must be further explored in future large-sample studies. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: PROSPERO CRD42023397883.
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Affiliation(s)
- Xiao-Yan Gong
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dong-Jiang Hou
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jing Yang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jia-li He
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ming-Jin Cai
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wei Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xian-Ying Lu
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jing Gao
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Linassi F, Kreuzer M, Kratzer S, Olivieri S, Zanatta P, Schneider G, Carron M. Unwanted spontaneous responsiveness and burst suppression in patients undergoing entropy-guided total intravenous anesthesia with target-controlled infusion: An observational prospective trial. J Clin Anesth 2023; 86:111045. [PMID: 36680980 DOI: 10.1016/j.jclinane.2022.111045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/14/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023]
Abstract
STUDY OBJECTIVE To estimate the incidence of unwanted spontaneous responsiveness and burst suppression (BSupp) in patients undergoing state entropy (SE) and surgical pleth index (SPI)-guided total intravenous anesthesia (TIVA) with target-controlled infusion (TCI). DESIGN Observational, prospective, single-center study. SETTINGS Operating room. PATIENTS 107 adult (<65 years) and elderly (≥65 years) women undergoing breast surgery. INTERVENTIONS Propofol-remifentanil TIVA-TCI-guided by SE for depth of anesthesia monitoring (target value 40-60) and SPI for antinociception monitoring (target value 20-50) without neuromuscular blockade. MEASUREMENTS Age; body mass index; American Society of Anesthesiologists physical status classification; concentration at the effect site of propofol (CeP) and remifentanil (CeR) at loss of responsiveness (LoR), median during anesthesia maintenance (MdM), and at return of responsiveness (RoR); propofol infusion duration; incidence of postoperative delirium (POD) with Confusing Assessment Method for the Intensive Care Unit. MAIN RESULTS During SE-SPI-guided TIVA-TCI, 13.1% of patients showed unwanted spontaneous responsiveness, whereas 45.8% showed BSupp. Unwanted spontaneous responsiveness was observed mainly in adults (p < 0.05), and higher CeP RoR (p < 0.05) was registered. BSupp was observed mainly in patients showing a lower CeP MdM (p < 0.01) and CeP RoR (p < 0.05). Unwanted spontaneous responsiveness and BSupp were not associated with significant differences in CeRs. An age-related hysteresis effect was observed, resulting in higher CeP LoR than CeP RoR (p < 0.001). 12.2% of patients showed POD. Only preoperative serum albumin was associated with increased likelihood of POD (p = 0.046). CONCLUSIONS The SE-SPI-guided TIVA-TCI did not prevent unwanted spontaneous responsiveness and BSupp. CeP RoR may be used as a proxy for anesthetic sensitivity.
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Affiliation(s)
- Federico Linassi
- Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, via Marzolo 5, 35131, Padova, Italy; Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, Treviso 31100, Italy.
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany
| | - Stephan Kratzer
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany
| | - Sara Olivieri
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, Treviso 31100, Italy
| | - Paolo Zanatta
- Department of Anesthesia and Intensive Care, Integrated University Hospital of Verona, Piazzale Aristide Stefani 1, Verona 37121, Italy
| | - Gerhard Schneider
- Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany
| | - Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
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Ko Y, Kim HE, Park JY, Kim JJ, Cho J, Oh J. Relationship between body mass index and risk of delirium in an intensive care unit. Arch Gerontol Geriatr 2023; 108:104921. [PMID: 36603359 DOI: 10.1016/j.archger.2023.104921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Delirium in the intensive care unit (ICU) is a common and critical condition that leads to poor prognosis in older patients, but the association between body mass index (BMI) and the incidence of delirium remains unclear. METHODS We retrospectively analyzed 5,622 patients admitted to the ICU of a tertiary referral hospital between 2013 and 2022. We collected sociodemographic data, vital signs, laboratory results, and delirium scale scores. We subdivided the patients into four categories: underweight (<18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), and obese (>25 kg/m2). The primary outcome was the incidence of delirium according to the BMI categories. We performed multivariable logistic regression analysis, adjusted for sex, age, past smoking and alcohol history, benzodiazepine use, and laboratory abnormalities. RESULTS Among the 5,622 patients in the ICU (mean age, 72.9 years; male, 60.1%; mean BMI, 24.2 kg/m2), the incidence of delirium was 19.0% (1,069 patients). The mean modified incidence of delirium was higher among underweight patients (odds ratio [OR]=1.51, confidence interval [CI]=1.07-2.12, p = 0.02) than among normal-weight patients. Overweight and obese status were not independently associated with delirium (OR=0.90, CI=0.70-1.17, p = 0.43; OR= 0.97; CI=0.77-1.21, p = 0.78, respectively). The area under the receiver-operating characteristic curve of the multivariable logistic regression model was 0.71 (95% CI=0.69-0.73). CONCLUSIONS Underweight status is an independent risk factor for delirium in the ICU. Additional caution is required when evaluating underweight patients for delirium. Obese or overweight status are not associated with delirium, providing evidence for the obesity paradox.
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Affiliation(s)
- Yujin Ko
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Hesun Erin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jin Young Park
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul 03722, Korea; Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Korea
| | - Jae-Jin Kim
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jaehwa Cho
- Department of Pulmonary and Critical Care Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Jooyoung Oh
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul 03722, Korea.
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Ji S, Li Z, Li M, Lu Y, Ma T, Qi H, Cui Y, Du B, Huang Q, Zhang K, Lin H, Yang Y. Relationship between neutrophil/lymphocyte ratio and postoperative delirium in elderly patients with proximal femoral nail anti-rotation for intertrochanteric fractures. Am J Transl Res 2023; 15:1367-1373. [PMID: 36915754 PMCID: PMC10006771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/11/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Delirium is a common postoperative complication in elderly patients with intertrochanteric femur fracture. This study aimed at analyzing risk factors for postoperative delirium (POD) in patients after proximal femoral nail anti-rotation (PFNA). METHODS From February 2017 to February 2021, we included elderly patients with intertrochanteric fractures who underwent PFNA. The predictive ability and cut-off value of neutrophil/lymphocyte ratio (NLR) for POD were evaluated using receiver operating characteristic (ROC) curve. Univariate and multivariate analyses were used to investigate the association between NLR and POD. RESULTS We enrolled 315 patients. The ROC curve suggested that NLR ≥ 4.85 was the optimal cut-off value for POD. The POD and non-POD groups differed significantly in age, diabetes, time from injury to operation, preoperative albumin level, neutrophil count, and NLR (P < 0.05). Logistic regression indicated that NLR ≥ 4.85 (odds ratio [OR] = 3.491; 95% confidence interval [CI]: 1.731-5.982; P < 0.001), old age (OR = 1.921; 95% CI: 1.267-4.125; P < 0.001), time from injury to operation ≥ 48 h (OR = 1.733; 95% CI: 1.212-3.542; P = 0.007), and preoperative albumin level ≤ 35 g/L (OR = 2.274; 95% CI: 1.662-4.846; P = 0.001) increased the risk of POD. CONCLUSION Old age, time from injury to operation ≥ 48 h, preoperative albumin level ≤ 35 g/L, and NLR ≥ 4.85 were independent risk factors for POD. Thus, NLR may predict POD in elderly patients with intertrochanteric femur fractures after PFNA.
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Affiliation(s)
- Shuai Ji
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an 710054, Shaanxi, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an 710054, Shaanxi, China
| | - Ming Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an 710054, Shaanxi, China
| | - Yao Lu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an 710054, Shaanxi, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an 710054, Shaanxi, China
| | - Hongfei Qi
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an 710054, Shaanxi, China
| | - Yu Cui
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an 710054, Shaanxi, China
| | - Bing Du
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an 710054, Shaanxi, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an 710054, Shaanxi, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an 710054, Shaanxi, China
| | - Hua Lin
- Department of Orthopaedic Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an 710054, Shaanxi, China
| | - Yanling Yang
- Medical College of Yan'an University Yan'an 716000, Shaanxi, China
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Yang Y, Wang T, Guo H, Sun Y, Cao J, Xu P, Cai Y. Development and Validation of a Nomogram for Predicting Postoperative Delirium in Patients With Elderly Hip Fracture Based on Data Collected on Admission. Front Aging Neurosci 2022; 14:914002. [PMID: 35783136 PMCID: PMC9243358 DOI: 10.3389/fnagi.2022.914002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/24/2022] [Indexed: 12/19/2022] Open
Abstract
Delirium is a common postoperative complication in elderly hip fracture patients that seriously affects patients’ lives and health, and early delirium risk prediction, and targeted measures can significantly reduce the incidence of delirium. The purpose of this study was to develop and validate a nomogram for the prediction of postoperative delirium (POD) in elderly hip fracture patients. A total of 328 elderly patients with hip fractures enrolled retrospectively in department 1 of our hospital were randomly divided into the training set (n = 230) and the internal validation set (n = 98). The least absolute shrinkage and selection operator (LASSO) regression analysis was used for feature variable selection, and multivariate logistic regression with a backward stepwise method was used to construct a nomogram in the training set. The discrimination efficacy and calibration efficacy of the nomogram were evaluated through the receiver operating characteristic (ROC) curve and calibration curve, respectively. The clinical usefulness was estimated through decision curve analysis (DCA) and clinical impact curve (CIC) analysis. Another validation set from department 2 of our hospital, containing 76 elderly patients with hip fractures, was used for external validation of the nomogram. A total of 43 (13.1%) and 12 (15.8%) patients had POD in department 1 and department 2, respectively. The nomogram was constructed by three predictors, including dementia, chronic obstructive pulmonary disease (COPD), and albumin level. The nomogram showed good discrimination efficacy and calibration efficacy, with the AUC of 0.791 (95% CI, 0.708–0.873), 0.820 (95% CI, 0.676–0.964), and 0.841 (95% CI, 0.717–0.966) in the training set, the internal validation set, and the external validation set, respectively. Both DCA and CIC demonstrated that this nomogram has good clinical usefulness. The nomogram constructed by dementia, COPD, and albumin level can be conveniently used to predict POD in patients with elderly hip fractures.
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Affiliation(s)
- Yin Yang
- Department of Orthopaedics, Xi’an Central Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Tianpei Wang
- Department of Orthopaedics, Xi’an Central Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Graduate School, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Hua Guo
- Department of Orthopaedics, Xi’an Central Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Ye Sun
- Department of Orthopaedics, Xi’an Central Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Graduate School, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Junjun Cao
- Department of Orthopaedics, Xi’an Central Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Peng Xu
- Department of Joint Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
- *Correspondence: Peng Xu Yongsong Cai
| | - Yongsong Cai
- Department of Joint Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
- *Correspondence: Peng Xu Yongsong Cai
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12
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Fei X, Zeng Q, Wang J, Gao Y, Xu F. Bibliometric Analysis of 100 Most-Cited Articles in Delirium. Front Psychiatry 2022; 13:931632. [PMID: 35873259 PMCID: PMC9298977 DOI: 10.3389/fpsyt.2022.931632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/09/2022] [Indexed: 12/19/2022] Open
Abstract
Delirium is a cognitive disorder with complex etiology, which brings a great burden to social health care. Articles with high citation frequency can provide important information about the current research situation in a certain field. Web of Science was used to search the 100 most-cited articles and we extracted key information, such as the authors, countries/regions, institutions, journals, and study types of these articles. CiteSpace was used to visually analyze the keywords. Our bibliometric analysis shows that the attention in this field continues to rise. Authors from the United States published the most articles and Inouye SK is the most influential author in the field. The journals that published these articles have high impact factors. Cohort studies are the main cited articles in this field, and there are a large number of systematic reviews or meta-analyses of cohort studies. Risk factors for delirium, psychometric evaluation, hospital care, and various clinical study design are still the focus of research. In short, we summarized the 100 most-cited articles in the field of delirium to identify the current status and global trends. These results enable researchers to understand the quality and trend of research in the field of delirium and make better use of the classical literature.
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Affiliation(s)
- Xinxing Fei
- Department of Psychiatry Chengdu Eighth People's Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, China
| | - Qiu Zeng
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jianxiong Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yaqian Gao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Fangyuan Xu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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