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Song C, Yu D, Li Y, Liu M, Zhang H, He J, Li J. Predictive value of the Naples prognostic score on postoperative delirium in the elderly with gastrointestinal tumors: a retrospective cohort study. BMC Geriatr 2024; 24:535. [PMID: 38902614 PMCID: PMC11188257 DOI: 10.1186/s12877-024-05113-y] [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: 03/20/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common complication among elderly patients after surgery. The Naples Prognostic Score (NPS), a novel prognostic marker based on immune-inflammatory and nutritional status, was widely used in the assessment of the prognosis of surgical patients. However, no study has evaluated the relationship between NPS and POD. The aim of this article was to investigate the association between NPS and POD and test the predictive efficacy of preoperative NPS for POD in elderly patients with gastrointestinal tumors. MATERIALS AND METHODS In the present study, we retrospectively collected perioperative data of 176 patients (≥ 60 years) who underwent elective gastrointestinal tumor surgery from June 2022 to September 2023. POD was defined according to the chart-based method and the NPS was calculated for each patient. We compared all the demographics and laboratory data between POD and non-POD groups. Univariate and multivariate logistic regression analysis was used to explore risk factors of POD. Moreover, the accuracy of NPS in predicting POD was further assessed by utilizing receiver operating characteristic (ROC) curves. RESULTS 20 had POD (11.4%) in a total of 176 patients, with a median age of 71 (65-76). The outcomes by univariate analysis pointed out that age, ASA status ≥ 3, creatinine, white blood cell count, fasting blood glucose (FBG), and NPS were associated with the risk of POD. Multivariate logistic regression analysis further showed that age, ASA grade ≥ 3, FBG and NPS were independent risk factors of POD. Additionally, the ROC curves revealed that NPS allowed better prognostic capacity for POD than other variables with the largest area under the curve (AUC) of 0.798, sensitivity of 0.800 and specificity of 0.667, respectively. CONCLUSION Age, ASA grade ≥ 3, and FBG were independent risk factors for POD in the elderly underwent gastrointestinal tumor surgery. Notably, the preoperative NPS was a more effective tool in predicting the incidence of POD, but prospective trials were still needed to further validate our conclusion. TRIAL REGISTRATION The registration information for the experiment was shown below. (date: 3rd January 2024; number: ChiCTR2400079459).
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Affiliation(s)
- Chenhao Song
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China
| | - Dongdong Yu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China
| | - Yi Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China
| | - Jinhua He
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei Province, 050051, China.
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White N, Bazo-Alvarez JC, Koopmans M, West E, Sampson EL. Understanding the association between pain and delirium in older hospital inpatients: systematic review and meta-analysis. Age Ageing 2024; 53:afae073. [PMID: 38610062 PMCID: PMC11014791 DOI: 10.1093/ageing/afae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/01/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE Delirium and pain are common in older adults admitted to hospital. The relationship between these is unclear, but clinically important. We aimed to systematically review the association between pain (at rest, movement, pain severity) and delirium in this population. METHODS PubMed, EMBASE, CINAHL, PsycINFO, Cochrane and Web of Science were searched (January 1982-November 2022) for Medical Subject Heading terms and synonyms ('Pain', 'Analgesic', 'Delirium'). Study eligibility: (1) validated pain measure as exposure, (2) validated delirium tool as an outcome; participant eligibility: (1) medical or surgical (planned/unplanned) inpatients, (2) admission length ≥ 48 h and (3) median cohort age over 65 years. Study quality was assessed with the Newcastle Ottawa Scale. We collected/calculated odds ratios (ORs) for categorical data and standard mean differences (SMDs) for continuous data and conducted multi-level random-intercepts meta-regression models. This review was prospectively registered with PROSPERO [18/5/2020] (CRD42020181346). RESULTS Thirty studies were selected: 14 reported categorical data; 16 reported continuous data. Delirium prevalence ranged from 2.2 to 55%. In the multi-level analysis, pain at rest (OR 2.14; 95% confidence interval [CI] 1.39-3.30), movement (OR 1.30; 95% CI 0.66-2.56), pain categorised as 'severe' (OR 3.42; 95% CI 2.09-5.59) and increased pain severity when measured continuously (SMD 0.33; 95% CI 0.08-0.59) were associated with an increased delirium risk. There was substantial heterogeneity in both categorical (I2 = 0%-77%) and continuous analyses (I2 = 85%). CONCLUSION An increase in pain was associated with a higher risk of developing delirium. Adequate pain management with appropriate analgesia may reduce incidence and severity of delirium.
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Affiliation(s)
- Nicola White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Juan Carlos Bazo-Alvarez
- Research Department of Primary Care and Population Health, University College London, London, UK
- Escuela de Medicina, Universidad Cesar Vallejo, Trujillo, Peru
| | - Michel Koopmans
- Respiratory Medicine Department, Erasmus Medical Centre in Rotterdam, Rotterdam, The Netherlands
| | - Emily West
- e-Referrals Service, NHS England, Redditch, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
- Department of Psychological Medicine, Royal London hospital, East London Foundation Trust, London, UK
- Centre for Psychiatry and Mental Health, Queen Mary University London, London, UK
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Cai C, Tao L, Li D, Wang L, Xiao E, Luo G, Yan Z, Wang Y, Li D. The prognostic value of age-adjusted Charlson comorbidity index in laparoscopic resection for hilar cholangiocarcinoma. Scand J Gastroenterol 2024; 59:333-343. [PMID: 38018772 DOI: 10.1080/00365521.2023.2286193] [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: 09/05/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
The prognostic role of the Age-Adjusted Charlson Comorbidity Index (ACCI) in hilar cholangiocarcinoma patients undergoing laparoscopic resection is unclear. To evaluate ACCI's effect on overall survival (OS) and recurrence-free survival (RFS), we gathered data from 136 patients who underwent laparoscopic resection for hilar cholangiocarcinoma at Zhengzhou University People's Hospital between 1 June 2018 and 1 June 2022. ACCI scores were categorized into high ACCI (ACCI > 4.0) and low ACCI (ACCI ≤ 4.0) groups. We examined ACCI's association with OS and RFS using Cox regression analyses and developed an ACCI-based nomogram for survival prediction. Our analysis revealed that higher ACCI scores (ACCI > 4.0) (HR = 2.14, 95%CI: 1.37-3.34) were identified as an independent risk factor significantly affecting both OS and RFS in postoperative patients with hilar cholangiocarcinoma (p < 0.05). TNM stage III-IV (HR = 7.42, 95%CI: 3.11-17.68), not undergoing R0 resection (HR = 1.58, 95%CI: 1.01-2.46), hemorrhage quantity > 350 mL (HR = 1.92, 95%CI: 1.24-2.97), and not receiving chemotherapy (HR = 1.89, 95%CI: 1.21-2.95) were also independent risk factors for OS. The ACCI-based nomogram accurately predicted the 1-, 2-, and 3-year OS rates, with Area Under the Curve (AUC) values of 0.818, 0.844, and 0.924, respectively. Calibration curves confirmed the nomogram's accuracy, and decision curve analysis highlighted its superior predictive performance. These findings suggest that a higher ACCI is associated with a worse prognosis in patients undergoing laparoscopic resection for hilar cholangiocarcinoma. The ACCI-based nomogram could aid clinicians in making accurate predictions about patient survival and facilitate individualized treatment planning.
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Affiliation(s)
- Chiyu Cai
- Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Lianyuan Tao
- Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Dongxiao Li
- Department of Digestive Diseases, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Liancai Wang
- Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Erwei Xiao
- Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Guanbin Luo
- Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Zhuangzhuang Yan
- Department of Hepatobiliary and pancreatic surgery, Henan University People's Hospital, Zhengzhou, China
| | - Yanbo Wang
- Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Deyu Li
- Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou University People's Hospital, Zhengzhou, China
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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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Ma Y, Sui D, Yang S, Yang X, Oldam J, Semel JL, Wang Z, Fang N. Optimal postoperative delirium prediction after coronary artery bypass grafting surgery: a prospective cohort study. Front Cardiovasc Med 2023; 10:1251617. [PMID: 38144372 PMCID: PMC10739452 DOI: 10.3389/fcvm.2023.1251617] [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: 07/02/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
Background Postoperative delirium (POD) presents as a serious neuropsychiatric syndrome in patients undergoing off-pump coronary artery bypass grafting (OPCABG) surgery. This is correlated with higher mortality, cognitive decline, and increased costs. The Age-adjusted Charlson Comorbidity Index (ACCI) is recognized as an independent predictor for mortality and survival rate. The purpose of our study is to estimate the predictive value of the ACCI on the POD in patients undergoing OPCABG surgery. Methods This prospective cohort study enrolled patients undergoing OPCABG surgery between December 2020 and May 2021 in Qilu Hospital. Patients were divided into the low-ACCI group (score, 0-3) and the high-ACCI group (score ≥4) according to their ACCI scores. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and CAM were used to diagnose POD within 7 days after surgery. The general, laboratory, and clinical data of the patients were recorded and collected. The characteristic ROC curve was applied to further assess the predictive value of the ACCI for POD in patients following OPCABG surgery. Results A total of 89 patients were enrolled, including 45 patients in the low-ACCI group and 44 patients in the high-ACCI group. The incidence of POD was higher in the high-ACCI group than in the low-ACCI group (45.5% vs. 15.6%, P = 0.003). Multivariate logistic regression analyses showed that the ACCI (OR, 2.433; 95% CI, 1.468-4.032; P = 0.001) was an independent risk factor for POD. The ACCI accurately predicted POD in patients following OPCABG surgery with an AUC of 0.738, and the Hosmer-Lemeshow goodness of fit test yielded X2 = 5.391 (P = 0.145). Conclusion The high-ACCI group showed a high incidence of POD. The ACCI was an independent factor associated with POD in patients following OPCABG surgery. In addition, the ACCI could accurately predict POD in patients following OPCABG surgery. Clinical Trial Registration ClinicalTrials.gov, identifier CHiCTR2100052811.
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Affiliation(s)
- Ying Ma
- Department of Geriatric Medicine, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Dongxin Sui
- Department of Respiration, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Shaozhong Yang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaomei Yang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Joseph Oldam
- B.S. Neuroscience, Center for Research on Cardiac Intermediate Filaments, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jessica L. Semel
- Centerfor Research on Cardiac Intermediate Filaments, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Zhihao Wang
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Ningning Fang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Guo K, Wang X, Lu X, Yang Y, Lu W, Wang S, Tang X, Wu Y, Xu Y, Chen Q, Liu S. Effects of sarcopenia and frailty on postoperative recovery in elderly patients: A prospective cohort study. J Cachexia Sarcopenia Muscle 2023; 14:2642-2652. [PMID: 37724506 PMCID: PMC10751444 DOI: 10.1002/jcsm.13337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Sarcopenia and frailty are both age-related declines in functional reserve that are linked to adverse health outcomes. It is critical to know about the outcomes of a combination of these conditions. The study aimed to investigate the effects of sarcopenia and frailty on postoperative recovery in elderly patients and to explore risk factors. METHODS This prospective cohort study was conducted among 608 patients aged ≥60 years, American Society of Anesthesiologists I-III, who were scheduled to undergo thoracic (non-cardiac) and abdominal surgery from 1 March 2022 to 31 October 2022 at the Affiliated Hospital of Xuzhou Medical University. Frailty was measured by the 28-item frailty index, and sarcopenia was assessed sarcopenia was assessed by skeletal muscle index in computed tomographic scan, handgrip strength and 6-m walk. Participants were classified as follows: Group A: both sarcopenia and frailty; Group B: sarcopenia only; Group C: frailty only; and Group D: neither frailty nor sarcopenia. The primary outcome was 90-day morbidity. Multivariable logistic regression model was used to estimate the association between sarcopenia, frailty and 90-day morbidity. RESULTS The median (interquartile range) age of participants was 68 (64-72) years, and 62.7% were men. The prevalence rates of sarcopenia and frailty were 32.8% and 47.6%, respectively. The 90-day morbidity in Group A was 58.5%, in Group B was 46.2%, in Group C was 42.0% and in Group D was 28.8%, and the difference was significant (P < 0.001). In the multivariable analysis, both sarcopenia and frailty [odds ratio (OR), 2.21; 95% confidence interval (CI), 1.26-3.89], sarcopenia only (OR, 1.84; 95% CI, 1.01-3.36), frailty only (OR, 1.77; 95% CI, 1.03-3.03), women (OR, 0.67; 95% CI, 0.45-0.99), body mass index (OR, 0.94; 95% CI, 0.88-0.99), pre-operative albumin (OR, 0.96; 95% CI, 0.91-1.00) and operative stress score (OSS) [OSS 3 (OR, 2.09; 95% CI, 1.21-3.67); OSS 4-5 (OR, 3.81; 95% CI, 2.31-6.42)] were independently associated with 90-day morbidity. In the multivariable analysis with inverse probability weighting adjusted cohort, sarcopenia and frailty were also significantly associated with 90-day morbidity. CONCLUSIONS Sarcopenia and frailty were associated with higher risks of postoperative 90-day morbidity in elderly patients alone and in combination. Sex, body mass index, pre-operative albumin and operative stress were also independent factors for postoperative morbidity within 90 days.
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Affiliation(s)
- Kedi Guo
- Department of AnesthesiologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Jiangsu Province Key Laboratory of AnesthesiologyXuzhou Medical UniversityXuzhouChina
| | - Xinghe Wang
- Department of AnesthesiologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Jiangsu Province Key Laboratory of AnesthesiologyXuzhou Medical UniversityXuzhouChina
- Department of AnesthesiologyXuzhou Central HospitalXuzhouChina
| | - Xian Lu
- Department of AnesthesiologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Jiangsu Province Key Laboratory of AnesthesiologyXuzhou Medical UniversityXuzhouChina
| | - Yuping Yang
- Department of AnesthesiologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Jiangsu Province Key Laboratory of AnesthesiologyXuzhou Medical UniversityXuzhouChina
| | - Wensi Lu
- Department of AnesthesiologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Jiangsu Province Key Laboratory of AnesthesiologyXuzhou Medical UniversityXuzhouChina
| | - Shuting Wang
- Department of AnesthesiologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Jiangsu Province Key Laboratory of AnesthesiologyXuzhou Medical UniversityXuzhouChina
| | - Xihui Tang
- Department of AnesthesiologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Jiangsu Province Key Laboratory of AnesthesiologyXuzhou Medical UniversityXuzhouChina
| | - Yan Wu
- Department of AnesthesiologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Jiangsu Province Key Laboratory of AnesthesiologyXuzhou Medical UniversityXuzhouChina
| | - Yuqing Xu
- Department of AnesthesiologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Jiangsu Province Key Laboratory of AnesthesiologyXuzhou Medical UniversityXuzhouChina
| | - Qingsong Chen
- Department of AnesthesiologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Jiangsu Province Key Laboratory of AnesthesiologyXuzhou Medical UniversityXuzhouChina
| | - Su Liu
- Department of AnesthesiologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Jiangsu Province Key Laboratory of AnesthesiologyXuzhou Medical UniversityXuzhouChina
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Dong B, Wang J, Li P, Li J, Liu M, Zhang H. The impact of preoperative malnutrition on postoperative delirium: a systematic review and meta-analysis. Perioper Med (Lond) 2023; 12:55. [PMID: 37884977 PMCID: PMC10604920 DOI: 10.1186/s13741-023-00345-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common postoperative complication, characterized by disturbance of attention, perception, and consciousness within 1 week after surgery, and linked to cognitive decline, increased mortality, and other serious surgical outcomes. Early identification and treatment of risk factors for POD could reduce the occurrence of delirium and the related poor outcomes. Malnutrition as a possible precipitating factor, defined as the poor anthropometric, functional, and clinical outcomes of nutrient deficiency, has been investigated. However, the evidence is controversial. The goal of this systematic review and meta-analysis was to comprehensively assess the correlation between preoperative malnutrition and POD. METHODS PubMed, Embase, Cochrane Library, and Web of Science were used to search prospective cohort articles that explored the correlation between preoperative malnutrition and POD from inception until September 30, 2022. Two researchers independently conducted the literature selection and data extraction. The quality of the literature was evaluated according to the Newcastle-Ottawa scale (NOS). Odds ratios (ORs) and 95% confidence intervals (CIs) for POD associated with malnutrition relative to normal nutritional status were calculated. RESULTS Seven prospective cohort studies qualified for the meta-analysis, which included 2701 patients. The pooled prevalence of preoperative malnutrition was 15.1% (408/2701), and POD occurred in 428 patients (15.8%). The NOS score was above 7 points in all 7 studies. Our results demonstrated that the pooled OR for malnutrition and POD was 2.32 (95% CI 1.62-3.32) based on a random-effects model. Our subgroup analysis suggested that the relationship between malnutrition and POD was significant in adults following noncardiac surgery (OR = 3.04, 95% CI, 1.99-4.62, P < 0.001), while there was no statistical significance in adults following cardiac surgery (OR = 1.76, 95% CI, 0.96-3.22, P = 0.07). Additionally, in the subgroup analysis based on different malnutrition assessment tools (MNA-SF versus others), a significant association was found in the MNA-SF group (OR = 3.04, 95% CI, 1.99-4.62, P < 0.001), but not in the others group (OR = 1.76, 95% CI, 0.96-3.22, P = 0.07). Other subgroup analyses showed that this association was not significantly affected by evaluation instruments for POD, location of the study, or quality of the article (all P < 0.05). CONCLUSIONS Based on the currently available evidence, our results suggested that preoperative malnutrition was independently associated with POD in adult surgical patients.
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Affiliation(s)
- Bo Dong
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
- Graduate Faculty, Hebei North University, Zhangjiakou, 075132, China
| | - Jing Wang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Pan Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China.
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
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Hu JH, Shi HJ, Han ZY, Liu H, Ji FH, Peng K. Protocol for Development and Validation of Multivariable Prediction Models for Chronic Postsurgical Pain Following Video-Assisted Thoracic Surgery. J Pain Res 2023; 16:2251-2256. [PMID: 37425224 PMCID: PMC10328098 DOI: 10.2147/jpr.s416450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Chronic postsurgical pain (CPSP) is a common complication after thoracic surgery and associated with long-term adverse outcomes. This study aims to develop two prediction models for CPSP after video-assisted thoracic surgery (VATS). Methods and Analysis This single-center prospective cohort study will include a total of 500 adult patients undergoing VATS lung resection (n = 350 for development and n = 150 for external validation). Patients will be enrolled continuously at The First Affiliated Hospital of Soochow University in Suzhou, China. The cohort for external validation will be recruited in another time period. The outcome is CPSP, which is defined as pain with the numerical rating scale score of 1 or higher 3 months after VATS. Univariate and multivariable logistic regression analyses will be performed to develop two CPSP prediction models based on patients' data of postoperative day 1 and day 14, respectively. For internal validation, we will use the bootstrapping validation technique. For external validation, the discrimination capability of the models will be assessed using the area under the receiver operating characteristic curve, and the calibration will be evaluated using the calibration curve and Hosmer-Lemeshow goodness-of-fit statistic. The results will be presented in model formulas and nomograms. Conclusion Based on the development and validation of the prediction models, our results contribute to early prediction and treatment of CPSP after VATS. Trial Registration Chinese Clinical Trial Register (ChiCTR2200066122).
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Affiliation(s)
- Jing-Hui Hu
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hai-Jing Shi
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Zhen-Yu Han
- Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Fu-Hai Ji
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Ke Peng
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
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Fu M, Zhang Y, Zhao Y, Guo J, Hou Z, Zhang Y, Wang Z. Characteristics of preoperative atrial fibrillation in geriatric patients with hip fracture and construction of a clinical prediction model: a retrospective cohort study. BMC Geriatr 2023; 23:310. [PMID: 37202743 DOI: 10.1186/s12877-023-03936-9] [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: 12/01/2022] [Accepted: 03/27/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Atrial fibrillation is the most common atrial arrhythmia in the perioperative period and is associated with prolonged hospital stay, increased costs, and increased mortality. However, there are few data on the predictors and incidence of preoperative atrial fibrillation in hip fracture patients. Our aim was to identify predictors of preoperative atrial fibrillation and to propose a valid clinical prediction model. METHODS Predictor variables included demographic and clinical variables. LASSO regression analyzes were performed to identify predictors of preoperative atrial fibrillation, and models were constructed and presented as nomograms. Area under the curve, calibration curve, and decision curve analysis (DCA) were used to examine the discriminative power, calibration, and clinical efficacy of the predictive models. Bootstrapping was used for validation. RESULTS A total of 1415 elderly patients with hip fractures were analyzed. Overall, 7.1% of patients had preoperative atrial fibrillation, and they were at significant risk for thromboembolic events. Patients with preoperative AF had a significantly longer delay in surgery than those without preoperative atrial fibrillation (p < 0.05). Predictors for preoperative atrial fibrillation were hypertension (OR 1.784, 95% CI 1.136-2.802, p < 0.05), C-reactive protein at admission (OR 1.329, 95% CI 1.048-1.662, p < 0.05), systemic inflammatory response index at admission (OR 2.137, 95% CI, 1.678-2.721 p < 0.05), Age-Adjusted Charlson Comorbidity Index (OR 1.542, 95% CI 1.326-1.794, p < 0.05), low potassium(OR 2.538, 95% CI 1.623-3.968, p < 0.05), anemia(OR 1.542, 95% CI 1.326-1.794, p < 0.05). Good discrimination and calibration effect of the model was showed. Interval validation could still achieve the C-index value of 0.799. DCA demonstrated this nomogram has good clinical utility. CONCLUSION This model has a good predictive effect on preoperative atrial fibrillation in elderly patients with hip fractures, which can help to better plan clinical evaluation.
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Affiliation(s)
- Mingming Fu
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yaqian Zhang
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yuqi Zhao
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopeadic Equipment (Third Hospital of Hebei Medical University), Hebei, China.
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopeadic Equipment (Third Hospital of Hebei Medical University), Hebei, China.
- Chinese Academy of Engineering, Beijing, 100088, People's Republic of China.
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
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Liu J, Li J, Gao D, Wang J, Liu M, Yu D. High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery. Clin Interv Aging 2023; 18:81-92. [PMID: 36700165 PMCID: PMC9869895 DOI: 10.2147/cia.s395893] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
Purpose This study was to investigate the incidence and potential predictive factors for postoperative delirium (POD) in older people following urinary calculi surgery, and to establish the corresponding risk stratification score by the significant factors to predict the risk of POD. Patients and Methods We retrospectively analyzed the perioperative data of 195 patients aged 65 or older who underwent elective urinary calculi surgery between September 2020 and September 2022. POD was defined by chart-based method, and the serum uric acid to creatinine (SUA/Cr) ratio as well as neutrophil-to-lymphocyte ratio (NLR) were calculated, respectively. Identification of the risk factors for POD was performed by univariate and multivariate logistic regression analysis. Moreover, the risk stratification score was developed based on the regression coefficients of the associated variables. Results In 195 eligible patients following urinary calculi surgery, the median age was 69 (66-72) and 19 patients ultimately developed POD (9.7%). The results by univariate analysis showed that patients with advanced age, high American Society of Anesthesiologists (ASA) physical status (≥3) and low SUA/Cr ratio (≤3.3) were more likely to develop POD, but dexmedetomidine can significantly decrease the risk of the occurrence of POD. The multivariate analysis further indicated that high ASA physical status (≥3) and low SUA/Cr ratio (≤3.3) were independently associated with POD, and the POD incidence could obviously be elevated with the increase of risk stratification score. Moreover, patients with delirium had longer hospital stays. Conclusion POD is frequent in geriatric patients following urinary calculi surgery (9.7%). The high ASA physical status (≥3) and low SUA/Cr ratio (≤3.3) were effective predictors of POD. The corresponding risk stratification based on these factors could be beneficial to determining patients who are susceptible to POD, and thus better preventing and reducing the occurrence of POD. However, large prospective studies are needed to confirm this finding.
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Affiliation(s)
- Jing Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang City, People’s Republic of China,Graduate Faculty, Hebei North University, Zhangjiakou City, People’s Republic of China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang City, People’s Republic of China,Correspondence: Jianli Li, Department of Anesthesiology, Hebei General Hospital, Shijiazhuang city, Hebei Province, 050051, People’s Republic of China, Tel +81 85988447, Email
| | - Dongyan Gao
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang City, People’s Republic of China
| | - Jing Wang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang City, People’s Republic of China
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang City, People’s Republic of China
| | - Dongdong Yu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang City, People’s Republic of China
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