Introduction

The purpose of this study was to evaluate whether the Geriatric-8 (G8) and the instrumental activities of daily living (IADL)-modified G8 are associated with the occurrence of postoperative delirium after major urological cancer surgery.

Materials and Methods

We retrospectively analyzed a total of 415 consecutive patients who underwent major urologic cancer surgery and were screened preoperatively using the G8 and the IADL-modified G8 at our institution between January 2020 and July 2021. For both the G8 and the IADL-modified G8, a cut-off value of 14 was used. All patients underwent perioperative management according to the Enhanced Recovery After Surgery protocol formulated at our institution. Delirium was diagnosed using the Confusion Assessment Method. The relationship between these screening tests and clinical variables was examined. Predictive accuracy was evaluated by the area under the receiver operating characteristic curve (AUC). To determine the risk factors for the occurrence of postoperative delirium, univariate and multivariate analyses were performed.

Results

Of the 415 patients, 160 (39%) were assigned to the low G8 (score ≤ 14) group and 166 (40%) to the low IADL-modified G8 (score ≤ 14) group. The median age of the patients was 72 years. Postoperative delirium occurred in 31 patients (7%). The AUC values for predicting postoperative delirium were 0.69 for the G8 and 0.71 for the IADL-modified G8. Multivariate analysis for the G8 showed that G8 ≤ 14 (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.2–6.0; P = 0.02), preoperative use of benzodiazepine (OR = 3.8; 95% CI = 1.6–8.6; P = 0.002), and operative time ≥ 237 min (OR = 3.3; 95% CI = 1.5–7.1; P = 0.003) were independent risk factors for postoperative delirium. Similarly, for the IADL-modified G8, IADL-modified G8 ≤ 14 (OR = 2.6; 95% CI = 1.1–5.8; P = 0.02), preoperative use of benzodiazepine (OR = 3.9; 95% CI = 1.7–8.8; P = 0.001), and operative time ≥ 237 min (OR = 3.3; 95% CI = 1.5–7.2; P = 0.003) were independent risk factors for postoperative delirium.

Discussion

The G8 and the IADL-modified G8 screening may allow for better identification of patients at risk of postoperative delirium.

中文翻译：

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G8 和 IADL 改良的 G8 筛查工具对泌尿系肿瘤大手术术后谵妄的预测价值

介绍

本研究的目的是评估 Geriatric-8 (G8) 和日常生活工具活动 (IADL) 改良的 G8 是否与主要泌尿系统癌症手术后术后谵妄的发生有关。

材料和方法

我们回顾性分析了 2020 年 1 月至 2021 年 7 月期间在我们机构接受主要泌尿系统癌症手术并使用 G8 和 IADL 改良 G8 进行术前筛查的总共 415 名连续患者。对于 G8 和 IADL 改良 G8，a使用 14 的截止值。所有患者均根据我们机构制定的加速康复外科方案进行围手术期管理。使用混乱评估方法诊断谵妄。检查了这些筛选试验和临床变量之间的关系。预测准确性通过接受者操作特征曲线 (AUC) 下的面积进行评估。为了确定术后谵妄发生的危险因素，进行了单变量和多变量分析。

结果

在 415 名患者中，160 名 (39%) 被分配到低 G8（评分 ≤ 14）组，166 名（40%）被分配到低 IADL 改良 G8（评分 ≤ 14）组。患者的中位年龄为 72 岁。31 名患者 (7%) 发生术后谵妄。G8 预测术后谵妄的 AUC 值为 0.69，IADL 改良 G8 为 0.71。G8 的多变量分析显示 G8 ≤ 14（比值比 [OR] = 2.6；95% 置信区间 [CI] = 1.2–6.0；P  = 0.02），术前使用苯二氮卓类药物（OR = 3.8；95% CI = 1.6 –8.6；P  = 0.002）和手术时间≥ 237 分钟（OR = 3.3；95% CI = 1.5–7.1；P  = 0.003）是术后谵妄的独立危险因素。同样，对于 IADL 修改后的 G8，IADL 修改后的 G8 ≤ 14（OR = 2.6；95% CI = 1.1–5.8；P  = 0.02）、术前使用苯二氮卓类药物（OR = 3.9；95% CI = 1.7–8.8；P  = 0.001）和手术时间≥ 237 分钟（OR = 3.3；95% CI = 1.5–7.2；P  = 0.003）是术后谵妄的独立危险因素。

讨论

G8 和 IADL 改良的 G8 筛查可以更好地识别有术后谵妄风险的患者。