Correlation of preoperative nutritional status and frailty with postoperative delirium in elderly patients undergoing non-cardiac surgery

MA Xuedong; ZHANG Jie; DUAN Fengmei

doi:10.7619/jcmp.20231542

Journal of Clinical Medicine in Practice > 2023 > 27(21): 120-124. > DOI: 10.7619/jcmp.20231542

MA Xuedong, ZHANG Jie, DUAN Fengmei. Correlation of preoperative nutritional status and frailty with postoperative delirium in elderly patients undergoing non-cardiac surgery[J]. Journal of Clinical Medicine in Practice, 2023, 27(21): 120-124. DOI: 10.7619/jcmp.20231542

Citation:

PDF (884 KB)

Correlation of preoperative nutritional status and frailty with postoperative delirium in elderly patients undergoing non-cardiac surgery

1.
Department of Anesthesia, Chengde Hospital of Traditional Chinese Medicine, Chengde, Hebei, 067000
2.
Department of Anesthesia, the Affiliated Hospital of Chengde Medical College, Chengde, Hebei, 067020

More Information

Received Date: May 11, 2023
Revised Date: July 07, 2023
Available Online: November 23, 2023

Graphical Abstract

Abstract

Abstract

Objective
To investigate the predictive value of preoperative nutritional status and frailty on postoperative delirium (POD) in elderly patients undergoing non-cardiac surgery.
Methods
Clinical data of 376 elderly patients undergoing non-cardiac surgery in our hospital from January 2020 to December 2022 were retrospectively collected via electronic medical record system, and were divided into POD group(80 cases) and non-POD group(296 cases) according to whether they developed POD within 5 d after surgery or not. Risk factors for POD were analyzed using multi-factor Logistic regression, and the value of malnutrition and debilitation in predicting POD was quantitatively assessed using receiver operating characteristic (ROC) curves.
Results
Univariate analysis showed that the proportions of patients aged over 70 years old, with diabetes, junior high school education or below, preoperative frailty and moderate to severe malnutrition in the POD group were higher than that in non-POD group(P < 0.05). Multifactor Logistic regression analysis showed that age>70 years (OR=1.398; 95%CI, 1.044 to 1.872), preoperative frailty (OR=1.706; 95%CI, 1.238 to 2.349) and preoperative moderate to severe malnutrition (OR=1.632; 95%CI, 1.282 to 2.079) were independent risk factors for POD in elderly patients with non-cardiac surgery. ROC curve showed that the area under the curve (AUC) of preoperative debilitation combined with moderate to severe malnutrition was 0.801 (95%CI, 0.754 to 0.847) for predicting POD in elderly patients undergoing non-cardiac surgery, which had better predictive efficacy than a single indicator.
Conclusion
Preoperative malnutrition and frailty are correlated with POD in elderly patients undergoing non-cardiac surgery, and the combined application can predict the risk of developing POD, identify high-risk population in early stage and implement targeted interventions to optimize perioperative management.
- postoperative delirium,
- debilitation,
- malnutrition,
- high-risk groups,
- risk factor

FullText(HTML)

References (20)

References

[1]	SWARBRICK C J, PARTRIDGE J S L. Evidence-based strategies to reduce the incidence of postoperative delirium: a narrative review[J]. Anaesthesia, 2022, 77(Suppl 1): 92-101.
[2]	TRIPP B A, DILLON S T, YUAN M, et al. Targeted metabolomics analysis of postoperative delirium[J]. Sci Rep, 2021, 11(1): 1521. doi: 10.1038/s41598-020-80412-z
[3]	OH E S, FONG T G, HSHIEH T T, et al. Delirium in older persons: advances in diagnosis and treatment[J]. JAMA, 2017, 318(12): 1161-1174. doi: 10.1001/jama.2017.12067
[4]	KO F C. Preoperative frailty evaluation: a promising risk-stratification tool in older adults undergoing general surgery[J]. Clin Ther, 2019, 41(3): 387-399. doi: 10.1016/j.clinthera.2019.01.014
[5]	LI T, LI J, YUAN L Y, et al. Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: the RAGA randomized trial[J]. JAMA, 2022, 327(1): 50-58. doi: 10.1001/jama.2021.22647
[6]	KOTFIS K, MARRA A, ELY E W. ICU delirium - a diagnostic and therapeutic challenge in the intensive care unit[J]. Anaesthesiol Intensive Ther, 2018, 50(2): 160-167. doi: 10.5603/AIT.a2018.0011
[7]	WILDES T S, MICKLE A M, BEN ABDALLAH A, et al. Effect of electroencephalography-guided anesthetic administration on postoperative delirium among older adults undergoing major surgery: the ENGAGES randomized clinical trial[J]. JAMA, 2019, 321(5): 473-483. doi: 10.1001/jama.2018.22005
[8]	VERMILLION S A, HSU F C, DORRELL R D, et al. Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients[J]. J Surg Oncol, 2017, 115(8): 997-1003. doi: 10.1002/jso.24617
[9]	BEGGS T, SEPEHRI A, SZWAJCER A, et al. Frailty and perioperative outcomes: a narrative review[J]. J Can D'anesthesie, 2015, 62(2): 143-157. doi: 10.1007/s12630-014-0273-z
[10]	MAZZOLA P, WARD L, ZAZZETTA S, et al. Association between preoperative malnutrition and postoperative delirium after hip fracture surgery in older adults[J]. J Am Geriatr Soc, 2017, 65(6): 1222-1228. doi: 10.1111/jgs.14764
[11]	DENT E, KOWAL P, HOOGENDIJK E O. Frailty measurement in research and clinical practice: a review[J]. Eur J Intern Med, 2016, 31: 3-10. doi: 10.1016/j.ejim.2016.03.007
[12]	BUZBY G P, KNOX L S, CROSBY L O, et al. Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients[J]. Am J Clin Nutr, 1988, 47(2 Suppl): 366-381.
[13]	ALDECOA C, BETTELLI G, BILOTTA F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium[J]. Eur J Anaesthesiol, 2017, 34(4): 192-214. doi: 10.1097/EJA.0000000000000594
[14]	VLISIDES P, AVIDAN M. Recent advances in preventing and managing postoperative delirium[J]. F1000Res, 2019, 8: F1000FacultyRev-F1000Faculty607.
[15]	ESMAEELI S, FRANCO-GARCIA E, AKEJU O, et al. Association of preoperative frailty with postoperative delirium in elderly orthopedic trauma patients[J]. Aging Clin Exp Res, 2022, 34(3): 625-631. doi: 10.1007/s40520-021-01961-5
[16]	MAHANNA-GABRIELLI E, ZHANG K, SIEBER F E, et al. Frailty is associated with postoperative delirium but not with postoperative cognitive decline in older noncardiac surgery patients[J]. Anesth Analg, 2020, 130(6): 1516-1523. doi: 10.1213/ANE.0000000000004773
[17]	FU D L, TAN X Y, ZHANG M, et al. Association between frailty and postoperative delirium: a meta-analysis of cohort study[J]. Aging Clin Exp Res, 2022, 34(1): 25-37. doi: 10.1007/s40520-021-01828-9
[18]	张莹, 胡玉萍, 郭宪, 等. 术前营养不良的老年病人全麻下髋关节置换术后谵妄的危险因素[J]. 实用老年医学, 2022, 36(12): 1203-1206. doi: 10.3969/j.issn.1003-9198.2022.12.005
[19]	孙珣, 胡小义, 周健, 等. 营养控制状况评分与老年非心脏手术患者术后谵妄的相关性研究[J]. 医学研究杂志, 2021, 50(4): 37-42. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYZ202104011.htm
[20]	ZHAO Y L, XIA X, XIE D M, et al. Geriatric Nutritional Risk Index can predict postoperative delirium and hospital length of stay in elderly patients undergoing non-cardiac surgery[J]. Geriatr Gerontol Int, 2020, 20(8): 759-764. doi: 10.1111/ggi.13963

Cited By

Get Citation

PDF

XML

Article views (87) PDF downloads (7)

Turn off MathJax

Article Contents

Abstract

References

Correlation of preoperative nutritional status and frailty with postoperative delirium in elderly patients undergoing non-cardiac surgery

Abstract

References

Catalog

Export File

Citation

Format

Content