Risk factors for postoperative delirium in frail elderly patients undergoing on-pump cardiac surgery and development of a prediction model—a prospective observational study

作者：Yinyin Ding, Ju Gao, Yali Ge, Tianfeng Huang, Yang Zhang · 发表于：Frontiers in Cardiovascular Medicine · 年份：2024 · DOI：10.3389/fcvm.2024.1425621 · 被引用次数：5 · 研究领域：Intensive Care Unit Cognitive Disorders、Cardiac, Anesthesia and Surgical Outcomes、Sepsis Diagnosis and Treatment

Background To identify the risk factors for postoperative delirium (POD) after cardiac surgery in frail elderly patients and develop a receiver operating characteristic (ROC) prediction model to confirm the effectiveness. Methods This was a prospective observational study, patients were assessed preoperatively according to the frailty index (FI) scale. Cerebral (SctO 2 ) was assessed at different time points using near-infrared spectroscopy (NIRS). On the basis of the occurrence of POD within 7 days after surgery, patients were divided into POD and non-POD groups. Risk factors were analyzed using logistic regression analysis, while their predictive values were evaluated using the receiver operating characteristic curve analysis. Results POD was significantly associated with frailty, lower preoperative MMSE scores, hyperlipidemia, diabetes, cerebrovascular disease, lower hemoglobin level, lower albumin level, longer operation time, longer CPB time, lower SctO 2 at T5, and lower SctO 2baseline ( P < 0.05). SrtO 2 and SmtO 2 did not differ significantly between groups. FI, preoperative MMSE score, and operation time as independent risk factors ( P < 0.05). Significant predictive value was demonstrated in all 3 variables ( P < 0.001; respectively). Among them, high sensitivity and specificity were observed with the FI (cut-off value 0.27, sensitivity 75%, specificity 73.5%) and operation time (cut-off value 237.5, sensitivity 62.5%, specificity 78.6%). Conclu...