Objective: 

To test the hypothesis that in surgical patients ≥70 years, preoperative cognitive impairment is independently associated with postoperative delirium.

Background: 

Postoperative delirium is common among elderly surgical patients and is associated with longer hospitalization and significant morbidity. Some evidence suggest that baseline cognitive impairment is an important risk factor. Routine screening for both preoperative cognitive impairment and postoperative delirium is recommended for older surgical patients. As of 2019, we implemented such routine preoperative screening in all elective surgical patients ≥70 years.

Methods: 

Retrospective single-center analysis of prospectively collected data between January and December 2020. All elective non-cardiac surgical patients ≥70 years without pre-existing dementia were included. Postoperative delirium, defined as 4A’s test score ≥4, was evaluated in the post-anesthesia care unit and during the initial two postoperative days. Patients’ electronic records were also reviewed for delirium symptoms and other adverse outcomes.

Results: 

Of 1518 eligible patients, 1338 (88%) were screened preoperatively (mean (SD) age 77 (6) years), of whom 21% (n=279) had cognitive impairment (Mini-Cog score ≤2). Postoperative delirium occurred in 15% (199/1338). Patients with cognitive impairment had more postoperative delirium (30% vs. 11%, aOR (95%CI) 3.3 (2.3-4.7)). They also had a higher incidence of a composite of postoperative complications (20% vs. 12%, aOR 1.8 (1.2-2.5)), and median one-day longer hospital stay (median [IQR] 6 [3,12] vs. 5 [3,9] days).

Conclusions: 

One fifth of elective surgical patients ≥70 years present to surgery with preoperative cognitive impairment. These patients are at increased risk of postoperative delirium and major adverse outcomes.

中文翻译：

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老年手术患者术前认知障碍和术后谵妄——一项回顾性大队列研究

客观的： 

检验以下假设：在 70 岁以上的手术患者中，术前认知障碍与术后谵妄独立相关。

背景： 

术后谵妄在老年手术患者中很常见，并且与较长的住院时间和显着的发病率相关。一些证据表明基线认知障碍是一个重要的风险因素。建议对老年手术患者进行术前认知障碍和术后谵妄的常规筛查。截至2019年，我们对所有≥70岁的择期手术患者实施了此类常规术前筛查。

方法： 

对 2020 年 1 月至 12 月期间前瞻性收集的数据进行回顾性单中心分析。纳入所有年龄≥70 岁且无痴呆史的选择性非心脏手术患者。术后谵妄定义为 4A 测试评分≥4，在麻醉后护理室和术后最初两天内进行评估。还检查了患者的电子记录是否有谵妄症状和其他不良后果。

结果： 

在 1518 名符合条件的患者中，1338 名 (88%) 接受了术前筛查（平均 (SD) 年龄 77 (6) 岁），其中 21% (n=279) 患有认知障碍（Mini-Cog 评分≤2）。术后谵妄发生率为 15% (199/1338)。认知障碍患者术后谵妄发生率更高（30% vs. 11%，aOR (95%CI) 3.3 (2.3-4.7)）。他们的术后综合并发症发生率也较高（20% vs. 12%，aOR 1.8 (1.2-2.5)），中位住院时间延长一天（中位 [IQR] 6 [3,12] vs. 5 [3,9] 天）。

结论： 

五分之一的年龄≥70 岁的择期手术患者在接受手术时患有术前认知障碍。这些患者术后谵妄和主要不良后果的风险增加。