Journal of the American Geriatrics Society · 2016
A Simple Tool to Predict Development of Delirium After Elective Surgery.
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Dworkin Andy, Lee David S H, An Amber R, Goodlin Sarah J
Аннотация
OBJECTIVES: To identify a quick clinical tool to assess the risk of delirium after elective surgery.
DESIGN: Prospective observational study.
SETTING: Preoperative assessment clinic at the Veterans Affairs Portland Health Care System.
PARTICIPANTS: Community-living veterans aged 65 and older scheduled for elective surgery requiring general or major anesthesia.
MEASUREMENTS: Confusion Assessment Method (CAM) or Family Confusion Assessment Method (FAM-CAM). Data on education, medications, substance use, Patient Health Questionnaire (PHQ-9), Study of Osteoporotic Fractures Frailty, Mini-Cog, and Charlson-Deyo score were collected preoperatively.
RESULTS: Of 114 veterans who agreed to participate, 76 completed the final delirium assessment. Ten of the 76 (13%) developed delirium in the 72 hours after surgery as assessed using the CAM or FAM-CAM. In bivariate analysis, factors that increased the odds of delirium at least three times were low education; poor PHQ-9, clock draw, word recall, Mini-Cog, and poor preoperative orientation scores; alcohol use; and higher comorbidities as measured using Charlson-Deyo index. Scoring the Mini-Cog from 0 to 5 had a higher predictive power (area under the receiving operating characteristic curve = 0.77) than other approaches to scoring the Mini-Cog. Other models did not significantly improve prediction of postoperative delirium risk and would be complicated to use in a clinical setting.
CONCLUSION: In this sample of veterans who had elective surgery with major anesthesia, Mini-Cog score predicted likelihood of postoperative delirium.
DESIGN: Prospective observational study.
SETTING: Preoperative assessment clinic at the Veterans Affairs Portland Health Care System.
PARTICIPANTS: Community-living veterans aged 65 and older scheduled for elective surgery requiring general or major anesthesia.
MEASUREMENTS: Confusion Assessment Method (CAM) or Family Confusion Assessment Method (FAM-CAM). Data on education, medications, substance use, Patient Health Questionnaire (PHQ-9), Study of Osteoporotic Fractures Frailty, Mini-Cog, and Charlson-Deyo score were collected preoperatively.
RESULTS: Of 114 veterans who agreed to participate, 76 completed the final delirium assessment. Ten of the 76 (13%) developed delirium in the 72 hours after surgery as assessed using the CAM or FAM-CAM. In bivariate analysis, factors that increased the odds of delirium at least three times were low education; poor PHQ-9, clock draw, word recall, Mini-Cog, and poor preoperative orientation scores; alcohol use; and higher comorbidities as measured using Charlson-Deyo index. Scoring the Mini-Cog from 0 to 5 had a higher predictive power (area under the receiving operating characteristic curve = 0.77) than other approaches to scoring the Mini-Cog. Other models did not significantly improve prediction of postoperative delirium risk and would be complicated to use in a clinical setting.
CONCLUSION: In this sample of veterans who had elective surgery with major anesthesia, Mini-Cog score predicted likelihood of postoperative delirium.
Предметные рубрики MeSH
Age FactorsAgedAged, 80 and overDeliriumElective Surgical ProceduresFemaleGeriatric AssessmentHumansIndependent LivingIntelligence TestsMaleMental Status ScheduleOregonPostoperative ComplicationsPredictive Value of TestsPreoperative CarePrognosisProspective StudiesResearch DesignRisk FactorsVeterans Health