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Gupta NK, Prvulovic ST, Zoghi S, Chmait HR, Covell MM, Sabet CJ, DeGenova DT, Moisi MD, Schmidt MH, Bowers CA. Complementary effects of postoperative delirium and frailty on 30-day outcomes in spine surgery. Spine J 2025; 25:966-973. [PMID: 39674405 DOI: 10.1016/j.spinee.2024.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 12/03/2024] [Indexed: 12/16/2024]
Abstract
BACKGROUND CONTEXT With an increasingly older population, the number of frail patients requiring surgical management for degenerative spine diseases is rapidly increasing. Older patients are at increased risk of developing postoperative delirium (POD), which increases the odds of postoperative morbidity and mortality in spine surgery patients. Therefore, frail spine surgery patients may be at greater risk of developing POD and subsequent adverse outcomes. PURPOSE To understand the relationship between frailty and POD in spine surgery patients, and the effect of POD on nonfatal and fatal adverse outcomes in frail patients. STUDY DESIGN/SETTING Retrospective cohort study utilizing data from the 2021 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. PATIENT SAMPLE Patients aged ≥75 years undergoing spine surgery screened for POD, with a total sample size of 4,195 patients. OUTCOME MEASURES Primary outcomes were postoperative delirium (POD), 30-day mortality, and nonfatal adverse outcomes. METHODS Frailty was measured using the Risk Analysis Index (RAI) with tiered cutoffs indicating increasing frailty. Statistical methods included multivariable logistic regression and mediation analysis to evaluate the relationships between RAI, postoperative delirium, and 30-day mortality. RESULTS Out of 4,195 spine surgery patients aged ≥75 years screened for POD, 353 (8.4%) exhibited POD. POD patients had significantly higher RAI scores relative to those without POD (p<.001). Multivariable analysis demonstrated that increasing frailty predicted POD (p<.001). In patients with POD, there were increased odds of mortality and all nonfatal adverse outcomes within 30 days (p<.001). A complementary mediation effect of POD on frailty's contribution to 30-day mortality was observed (p<.001). CONCLUSION POD and increasing preoperative frailty RAI scores were independent predictors of mortality and morbidity in older spine surgery patients. POD has a significant synergistic contribution to the adverse effects of frailty following spine surgery. The RAI may be used to identify frail patients at risk of developing POD to enable optimal surgical candidate selection and provide opportunities for risk mitigation, such as prehabilitation and/or specialized perioperative care teams for frail patients.
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Affiliation(s)
- Nithin K Gupta
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA.
| | - Stefan T Prvulovic
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA; School of Medicine, Georgetown University, Washington DC, USA
| | - Sina Zoghi
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA; Student Research Committee, Shiraz, University of Medical Sciences, Shiraz, Iran
| | - Hikmat R Chmait
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA; Department of Orthopedic Surgery, University of Vermont Larner College of Medicine, Burlington VT, USA
| | - Michael M Covell
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA; School of Medicine, Georgetown University, Washington DC, USA
| | - Cameron J Sabet
- School of Medicine, Georgetown University, Washington DC, USA
| | | | - Marc D Moisi
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA; Hurley Neurological Center, Hurley Medical Center, Flint, MI, USA; Michigan State College of Medicine, Flint, MI, USA
| | - Meic H Schmidt
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA; Maine Medical Center, Portland, ME, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA; Michigan State College of Medicine, Flint, MI, USA
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Liang L, Liang L, Huang Y, Liang H, Su J, Zhou Y. Incidence and Risk Factors of In-Hospital Gastrointestinal-Related Complications Following Bariatric Surgery: A Retrospective Nationwide Inpatient Sample Database Study. Obes Surg 2025; 35:1790-1799. [PMID: 40156751 DOI: 10.1007/s11695-025-07840-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 03/05/2025] [Accepted: 03/25/2025] [Indexed: 04/01/2025]
Abstract
BACKGROUND Obesity is associated with numerous serious physiological and psychological health problems. Bariatric surgery (BS) remains the most effective treatment for obesity, but early postoperative gastrointestinal complications may require additional surgical intervention. The objective of this study was to analyze gastrointestinal-related complications (GRCs) and their risk factors following BS, including sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), using a nationwide database. METHODS An analysis of the Nationwide Inpatient Sample data from 2010 to 2019 was conducted to compare patients following BS with versus without postoperative GRCs. Variables included demographics, hospital characteristics, length of stay, costs, comorbidities, and complications. Risk factors were identified through stepwise multivariate logistic regression. RESULTS Among 323,066 BS patients, 12,248 (3.79%) developed GRCs, with a decreasing trend observed over the study period. Common complications included gastrointestinal bleeding (1.37%), bowel obstruction (1.84%), and anastomotic issues (0.99%). Significant risk factors included advanced age, anemia (deficiency and chronic blood loss), cardiovascular conditions (heart failure, valve disease, peripheral vascular disorders), coagulation abnormalities, rheumatoid arthritis or collagen vascular diseases, drug abuse, electrolyte imbalances, neurological conditions, renal failure, non-bleeding peptic ulcer disease, and weight loss. Interestingly, liver disease emerged as a risk factor for GRCs after SG while acting as a protective factor for GRCs after RYGB. CONCLUSION Understanding the risk factors for GRCs after BS would allow for improved patient management and clinical outcomes.
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Affiliation(s)
- Lingli Liang
- Deparement of Radiology, Xiaolan People's Hospital of ZhongShan, Guangdong, China
| | - Luansheng Liang
- Deparement of Bariatric and Metabolic Diseases Surgery, Xiaolan People's Hospital of ZhongShan, Guangdong, China
| | - Yangguang Huang
- Deparement of Radiology, Xiaolan People's Hospital of ZhongShan, Guangdong, China
| | - Haimao Liang
- Deparement of Radiology, Xiaolan People's Hospital of ZhongShan, Guangdong, China
| | - Jianghua Su
- Deparement of Radiology, Xiaolan People's Hospital of ZhongShan, Guangdong, China
| | - Yanling Zhou
- Deparement of Radiology, Xiaolan People's Hospital of ZhongShan, Guangdong, China.
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Zakieh O, Jawid MY, Bowers MF, Young MW, Zuckerman SL, Lugo-Pico JG, Gardocki RJ, Abtahi AM, Stephens BF. Should We Operate on Octogenarians With Cervical Myelopathy or Radiculopathy? Spine (Phila Pa 1976) 2025; 50:E122-E127. [PMID: 39618175 DOI: 10.1097/brs.0000000000005232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Accepted: 11/20/2024] [Indexed: 03/09/2025]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE Investigate the disparities between octogenarians and nonoctogenarians undergoing cervical spine surgery regarding perioperative, and postoperative outcomes. SUMMARY OF BACKGROUND DATA As the population ages, the demand for elective cervical spine surgery among older, more active adults increases. However, concerns remain regarding the optimal management of older patients undergoing cervical surgery, given the potential complexities associated with advanced age, comorbidities, and physiological decline. While the safety and efficacy of cervical spine surgery in younger cohorts have been extensively studied, there is a paucity of literature specifically addressing outcomes in octogenarians. MATERIALS AND METHODS Octogenarians undergoing elective cervical spine surgery were propensity matched 3:1 to patients below 80 years old by baseline neck and arm pain, surgical approach, and total instrumented levels. Primary outcomes of interest were postoperative complications, unexpected 90-day hospital readmissions and 12-month reoperation. Secondary outcomes were 12-month patient satisfaction and patient-reported outcome measures (PROMs) at 3 and 12 months, including EuroQol-5D, modified Japanese Orthopaedic Association, neck disability index, and visual analog scale for neck and arm pain. RESULTS There were 29 octogenarians and 87 nonoctogenarians identified. The mean age in each cohort was 82.4±2.2 vs. 59.1±11.1 years, respectively. There was no difference in postoperative complications (10.3% vs. 6.9%, P =0.548), 90-day readmission (10.3% vs. 6.9%, P =0.548), and 12-month reoperation (3.4% vs. 2.3%, P =0.736) between octogenarians and nonoctogenarians. Similarly, octogenarians and nonoctogenarians experienced comparable 12-month patient satisfaction (65.2% vs. 55.3%, P =0.393), improvement in 3- and 12-month PROMs, and MCID achievement. CONCLUSIONS Postoperative complications, readmission, reoperation rate, patient satisfaction, and PROMs did not significantly differ between octogenarians and nonoctogenarians undergoing cervical spine surgery. These findings suggest that age alone should not be a determining factor in surgical decision-making for elective cervical spine procedures, as octogenarians can achieve comparable outcomes to their younger counterparts.
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Affiliation(s)
- Omar Zakieh
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Mitchell F Bowers
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Mason W Young
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Julian G Lugo-Pico
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Raymond J Gardocki
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amir M Abtahi
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Byron F Stephens
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
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Xie B, Nie L, Zhong B, Xiong J, Nie M, Ai Q, Yang D. Longitudinal Trends in the Incidence of Hyperactive Delirium and Its Causes of Change After Surgery for Degenerative Lumbar Disease: A Population-Based Study of 7250 Surgical Patients Over 11 Years. Orthop Surg 2025; 17:714-723. [PMID: 39648042 PMCID: PMC11872372 DOI: 10.1111/os.14301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 11/01/2024] [Accepted: 11/05/2024] [Indexed: 12/10/2024] Open
Abstract
OBJECTIVES Delirium is one of the common complications in elderly patients after spinal surgery. Severe delirium can lead to a series of adverse consequences such as drainage tube removal, wound rupture, patient falls, and severe adverse effects. The current research on POD is mostly small sample studies. This study aimed to investigate longitudinal changes in the incidence of hyper-postoperative delirium in patients with lumbar degenerative disease at our institution over the past 11 years and to identify the potential causes of these changes. METHODS This is a retrospective cohort study included 7250 patients who underwent surgical treatment for lumbar degenerative diseases at a single center from 2011 to 2021. These patients were diagnosed with delirium through the Confusion Assessment Method and then diagnosed with high activity delirium through the Richmond Agitation-Sedation Scale, totaling 130 cases. According to the incidence rate of hyper-postoperative delirium within 11 years, the trend test is divided into three groups: S1 upward trend (2011-2014), S2 downward trend (2015-2016) and S3 upward trend (2016-2021). The study collected variables from patients before, during, and after surgery, including gender, age, laboratory tests, anesthesia risk score, New York Heart Association cardiac function grading, number of surgical segments, surgical time, estimated intraoperative blood loss, anesthesia medication, and supplementary analgesic medication in the ward within 3 days after surgery. Kruskal Wallis one-way ANOVA test, Kruskal-Wallis H test, or chi-square test are used to evaluate inter group differences. p < 0.05 is considered statistically significant. RESULTS The pooled incidence of hyper-postoperative delirium over the past 11 years was 1.79% (130/7250). The average age of 7250 patients was 54.5 ± 13 years, with a male/female ratio close to 1:1. We statistically analyzed the relevant influencing factors before, during, and after surgery of S1 and S3 in the incidence rate increase group and found no statistical difference between the two groups. Our research results show that the incidence of high activity delirium is correlated with age, number of surgical segments, surgical duration, use of dexmedetomidine, remifentanil, and benzodiazepines, with p < 0.05. CONCLUSIONS The reduced use of dexmedetomidine, increased use of benzodiazepines, and prolonged surgical time are the reasons for the increased incidence of hyper-postoperative delirium. The joint management of orthopedic surgeons and anesthesiologists during the perioperative period is of great significance in reducing the incidence of hyper-postoperative delirium in patients undergoing lumbar spine surgery.
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Affiliation(s)
- Bang‐Lin Xie
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
- The Key Laboratory of Spine and Spinal Cord Disease of Jiangxi ProvinceNanchangChina
| | - Li‐Zhong Nie
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
- Department of OrthopedicsNanchang People's Hospital (The Third Hospital of Nanchang)NanchangChina
| | - Biao Zhong
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Jun Xiong
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Miao Nie
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Qiu‐Xiao Ai
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Dong Yang
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
- The Key Laboratory of Spine and Spinal Cord Disease of Jiangxi ProvinceNanchangChina
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Luo J, Tang Y, Cao J, Li W, Zheng L, Lin H. Application of an enhanced recovery after surgery care protocol in patients undergoing lumbar interbody fusion surgery: a meta-analysis. J Orthop Surg Res 2025; 20:154. [PMID: 39934844 PMCID: PMC11812206 DOI: 10.1186/s13018-025-05523-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 01/20/2025] [Indexed: 02/13/2025] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) has been widely used in several surgical fields. This meta-analysis compared the clinical outcomes of the ERAS protocol and standard care (SC) in patients who underwent lumbar interbody fusion surgery. MATERIALS AND METHODS The PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched to identify studies reporting the effects of the ERAS protocol on clinical outcomes in patients who underwent lumbar interbody fusion surgery. RESULTS Overall, 15 studies involving 17 865 patients were included in the final analysis. With the ERAS protocol, the length of hospitalization (SMD: - 0.47, 95% CI - 0.56 to -0.38), postoperative complications (OR = 0.62; 95% CI 0.50 to 0.77), operation time (SMD = - 0.26; 95% CI - 0.44 to -0.09), postoperative pain (SMD = - 0.35; 95% CI - 0.64 to -0.07) and duration of ambulation (SMD = - 0.80; 95% CI - 1.02 to - 0.58) were significantly reduced. The rates of readmission (OR = 0.63; 95% CI 0.38 to 1.04), estimated blood loss (SMD = - 0.31; 95% CI - 0.69 to 0.06) and hospitalization costs (SMD: - 0.56, 95% CI - 1.27 to 0.14) did not significantly differ between the ERAS and SC groups. CONCLUSIONS The present meta-analysis indicated that the ERAS protocol could be safely and feasibly implemented in the perioperative management of patients receiving lumbar interbody fusion surgery. The protocol significantly reduced the length of hospitalization, incidence of postoperative complications, operation time, duration of 1st ambulation and duration of postoperative pain. However, no differences were observed in estimated blood loss, readmission rates or hospitalization costs.
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Affiliation(s)
- Jianghong Luo
- Department of Orthopedics, Chengdu Sixth People's Hospital, Chengdu, Sichuan, China
| | - Yixin Tang
- Department of Medical Cosmetology, Sichuan Mianyang 404 Hospital, Mianyang, Sichuan, China
| | - Jing Cao
- School of Clinic Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Wei Li
- Department of Orthopedics, Chengdu Sixth People's Hospital, Chengdu, Sichuan, China
| | - Liu Zheng
- Department of Hepatobiliary Pancreatic Surgery, Chengdu Sixth People's Hospital, Chengdu, Sichuan, China.
| | - Haomin Lin
- Department of Hepatobiliary Pancreatic Surgery, Chengdu Sixth People's Hospital, Chengdu, Sichuan, China.
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Hu X, Liu L, Da X, Zhu S, Wang J, Shan M, Liu Y, He Z, Xu G. Anesthesia/surgery leads to blood-brain barrier disruption via the transcellular and paracellular pathways, and postoperative delirium-like behavior: A comparative study in mice of different ages. Exp Neurol 2025; 383:115044. [PMID: 39505249 DOI: 10.1016/j.expneurol.2024.115044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 10/24/2024] [Accepted: 11/03/2024] [Indexed: 11/08/2024]
Abstract
AIMS Postoperative delirium (POD) is a common complication of anesthesia and surgery, with a higher incidence in elderly patients. Disruption of the blood-brain barrier (BBB) is considered one of the key mechanisms underlying POD. Therefore, the present study aimed to investigate the effects of different BBB permeability alteration pathways on POD in mice of various ages. METHODS C57BL/6 J mice aged 4 and 16 months underwent exploratory laparotomy under sevoflurane anesthesia. Behavioral tests were conducted 24 h prior to surgery, as well as 6, 9, and 24 h postoperatively. Frontal cortex tissue was collected to detect the levels of BBB-related proteins and mRNA. RESULTS At 6 and 9 h after anesthesia/surgery, 4-month-old mice showed poorer performance on behavioral tests than their untreated counterparts. However, 16-month-old mice exhibited worse behavioral test results at 6, 9, and 24 h after surgery. Anesthesia/surgery 6 h postoperatively increased the expression of vesicle-associated proteins, and BBB leakage in 4-month-old mice. In 16-month-old mice, anesthesia/surgery altered the expression of tight junction proteins, vesicle-associated proteins, and BBB leakage at 6 and 24 h postoperatively. CONCLUSION Overall, our results suggest that anesthesia/surgery leads to age-dependent cognitive decline, and is associated with differences in the BBB injury pathways among mice of different ages. The transcellular pathway (transcytosis), compared to the paracellular pathway (tight junction), is more vulnerable to damage following anesthesia/surgery. This study provides new evidence for the improvement of POD through protection of the BBB.
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Affiliation(s)
- Xudong Hu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China; Key Laboratory of Anesthesiology and perioperative Medicine of Anhui higher Education institutes, Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China
| | - Lixia Liu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China; Key Laboratory of Anesthesiology and perioperative Medicine of Anhui higher Education institutes, Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China
| | - Xin Da
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China; Key Laboratory of Anesthesiology and perioperative Medicine of Anhui higher Education institutes, Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China
| | - Sihui Zhu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China; Key Laboratory of Anesthesiology and perioperative Medicine of Anhui higher Education institutes, Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China
| | - Jiawei Wang
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China; Key Laboratory of Anesthesiology and perioperative Medicine of Anhui higher Education institutes, Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China
| | - Menglei Shan
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China; Key Laboratory of Anesthesiology and perioperative Medicine of Anhui higher Education institutes, Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China
| | - Yinuo Liu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China; Key Laboratory of Anesthesiology and perioperative Medicine of Anhui higher Education institutes, Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China
| | - Ziqing He
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China; Key Laboratory of Anesthesiology and perioperative Medicine of Anhui higher Education institutes, Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China
| | - Guanghong Xu
- Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China; Key Laboratory of Anesthesiology and perioperative Medicine of Anhui higher Education institutes, Anhui Medical University, 218 Jixi Road, Hefei, Anhui 230022, China.
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Zheng Y, Wang J, Liu Z, Wang J, Yang Q, Ren H, Feng L. Incidence and Risk Factors of Postoperative Delirium in Lumbar Spinal Fusion Patients: A National Database Analysis. World Neurosurg 2025; 193:593-604. [PMID: 39442689 DOI: 10.1016/j.wneu.2024.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 10/10/2024] [Accepted: 10/14/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND Postoperative delirium (POD) is a frequent complication observed in patients following spinal surgeries. The incidence of POD is particularly concerning for major procedures like lumbar spinal fusion, leading to a range of detrimental outcomes. However, existing research on the prevalence and risk factors associated with POD after lumbar spinal fusion is limited, especially when relying on data from large-scale national databases. METHODS This study employed a comprehensive analysis of the National Inpatient Sample database, encompassing data from 2010 to 2019. The study population included patients who underwent primary lumbar spinal fusion surgery. We compared patients who did not experience POD with those who developed POD postoperatively, analyzing demographic characteristics, pre-existing comorbidities, and perioperative complications. RESULTS Analysis of the National Inpatient Sample database identified a total of 493,481 patients who underwent lumbar spinal fusion. The overall incidence of POD following the procedure was 1.07%. Patients who experienced delirium postoperatively exhibited significantly longer hospital stays, incurred higher healthcare costs, and faced a heightened risk of in-hospital mortality (P < 0.001). Additionally, POD following lumbar spinal fusion was associated with various medical complications, including acute renal failure, myocardial infarction, pneumonia, pulmonary embolism, stroke, and urinary tract infections. Several independent predictors were identified as being significantly associated with POD, including advanced age (≥ 65 years), pre-existing neurological disorders, a history of alcohol or drug abuse, depression, psychotic disorders, fluid and electrolyte imbalances, diabetes, weight loss, deficiency anemia, coagulopathy, congestive heart failure, pulmonary circulation disorders, peripheral vascular disease, chronic renal insufficiency, and receiving treatment at a teaching hospital. Notably, neurological disorders demonstrated the strongest correlation with the development of POD. CONCLUSIONS Overall, our analysis revealed a relatively low prevalence of POD following lumbar spinal fusion surgery. Nevertheless, it is critical to investigate and understand the independent predictors of POD to effectively prevent and mitigate its negative impact on patient outcomes.
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Affiliation(s)
- Yurong Zheng
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiajian Wang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China; National Clinical Research Center for Kidney Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhaofeng Liu
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hailong Ren
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lan Feng
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Gouzoulis MJ, Jabbouri SS, Seddio AE, Moran J, Day W, Ratnasamy PP, Grauer JN. Rate and risk factors for inpatient falls following single-level posterior lumbar fusion: A national registry study. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 20:100549. [PMID: 39318705 PMCID: PMC11417567 DOI: 10.1016/j.xnsj.2024.100549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/07/2024] [Accepted: 08/09/2024] [Indexed: 09/26/2024]
Abstract
Background Posterior lumbar fusion (PLF) is frequently considered for various spinal pathologies. While many outcome metrics have been assessed, to our knowledge, there has yet to be literature specifically investigating inpatient falls (IPFs) and its risk factors. Methods Adult patients who underwent single-level PLF were abstracted from the 2010-Q1 2022 M161Ortho PearlDiver Database. Patients who had an IPF were determined based on administrative coding. Various patient variables were extracted and variables independently associated with IPFs were assessed with multivariate logistic regression. Incidence of secondary injuries and cost incurred related to the IPF were determined. Results Of the 342,890 patients who underwent PLF, IPF was identified for 4,379 (1.4%). Independent predictors of an IPF in decreasing odds ratio (OR) order were those with: active psychosis (OR=3.35), active delirium (OR=2.83), history of falling (OR=2.47), commercial insurance (OR=1.59 relative to Medicare), Medicaid insurance (OR=1.47 relative to Medicare), dementia (OR=1.17), older age (OR=1.12 per decade), alcohol use disorder (O=1.11), higher comorbidity (OR=1.08 per Elixhauser comorbidity index point) (p<.05 for each).Of patients with IPF, 44 (1.0%) sustained a head injury, and 42 (1.0%) sustained a fracture. On average, those with IPF incurred greater inpatient costs compared to patients who did not ($36,865 vs. $33,921, p<.001). Conclusion In this national sample of patients who underwent single-level PLF, postoperative IPFs were identified for 1.4% and were associated with defined patient variables. These findings have potential patient outcome, financial, and medicolegal implications and should help guide refinement of fall prevention programs.
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Affiliation(s)
- Michael J. Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Sahir S. Jabbouri
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Anthony E. Seddio
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Wesley Day
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Philip P. Ratnasamy
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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Labib M, Deljou A, Morgan RJ, Schroeder DR, Sprung J, Weingarten TN. Associations Between Oversedation and Agitation in Postanesthesia Recovery Room and Subsequent Severe Behavioral Emergencies. J Patient Saf 2024; 20:535-541. [PMID: 39190419 DOI: 10.1097/pts.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
OBJECTIVES Hospital-based behavioral emergency response teams (BERT) respond to acute behavioral disturbances among hospitalized patients. We aimed to examine associations between altered mental status in postanesthesia care unit (PACU) and behavioral disturbances on surgical wards requiring BERT activation. METHODS Electronic medical records of patients who underwent general anesthesia and were admitted to the PACU between May 2018-December 2020 were reviewed for episodes of BERT activations on surgical wards. Characteristics of BERT patients were compared with the rest of surgical population during the same period to examine risk factors for BERT. RESULTS Of 56,275 adult surgical patients, 133 patients had 178 BERT activations (incidence 2.4, 95% confidence interval [CI] 2.0-2.8 per 1000 admissions), with 21 being for physical assault. The risk for BERT activation was increased with each decade over age of 50 as well as younger age (30 versus 50 y), male sex (odds ratio [OR] = 2.48, 95% CI 1.69, 3.62), longer procedures (OR = 1.08 per 30 minutes, 95% CI 1.05, 1.11), and alterations in mental status in PACU, with both moderate/deep sedation (OR = 1.63, 95% CI 1.04, 2.57) and agitation/combative state (OR = 8.47, 95% CI 5.13, 14.01), P < 0.001 for all comparisons. CONCLUSIONS Early postoperative agitation and oversedation are associated with BERT activation on surgical wards. Altered mental status in PACU should be conveyed to accepting hospital units so healthcare staff can be vigilant for the potential development of behavioral disturbances.
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Affiliation(s)
- Mary Labib
- From the Departments of Anesthesiology and Perioperative Medicine
| | - Atousa Deljou
- From the Departments of Anesthesiology and Perioperative Medicine
| | | | - Darrell R Schroeder
- Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Juraj Sprung
- From the Departments of Anesthesiology and Perioperative Medicine
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10
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Heard JC, Ezeonu T, Lee Y, Narayanan R, Issa T, McCall C, Dulitzki Y, Resnick D, Zucker J, Shaer A, Kurd M, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD, Canseco JA. Impact of Weekday on Short-term Surgical Outcomes After Lumbar Fusion Surgery. Clin Spine Surg 2024; 37:E377-E382. [PMID: 38490974 DOI: 10.1097/bsd.0000000000001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/22/2024] [Indexed: 03/18/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purpose of this study is to investigate whether weekday lumbar spine fusion surgery has an impact on surgical and inpatient physical therapy (PT) outcomes. SUMMARY OF BACKGROUND DATA Timing of surgery has been implicated as a factor that may impact outcomes after spine surgery. Previous literature suggests that there may be an adverse effect to having surgery on the weekend. METHODS All patients ≥18 years who underwent primary lumbar spinal fusion from 2014 to 2020 were retrospectively identified. Patients were subdivided into an early subgroup (surgery between Monday and Wednesday) and a late subgroup (surgery between Thursday and Friday). Surgical outcome variables included inpatient complications, 90-day readmissions, and 1-year revisions. PT data from the first inpatient PT session included hours to PT session, AM-PAC Daily Activity or Basic Mobility scores, and total gait trial distance achieved. RESULTS Of the 1239 patients identified, 839 had surgery between Monday and Wednesday and 400 had surgery between Thursday and Friday. Patients in the later surgery subgroup were more likely to experience a nonsurgical neurologic complication (3.08% vs. 0.86%, P =0.008); however, there was no difference in total complications. Patients in the early surgery subgroup had their first inpatient PT session earlier than patients in the late subgroup (15.7 vs. 18.9 h, P <0.001). However, patients in the late subgroup achieved a farther total gait distance (98.2 vs. 75.4, P =0.011). Late surgery was a significant predictor of more hours of PT (est.=0.256, P =0.016) and longer length of stay (est.=2.277, P =0.001). There were no significant differences in readmission and revision rates. CONCLUSIONS Patients who undergo surgery later in the week may experience more nonsurgical neurologic complications, longer wait times for inpatient PT appointments, and longer lengths of stay. This analysis showed no adverse effect of later weekday surgery as it relates to total complications, readmissions, and reoperations. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jeremy C Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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11
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Knebel A, Singh M, Rasquinha R, Daher M, Nassar JE, Hanna J, Diebo BG, Daniels AH. Postoperative Delirium Following Posterior Lumbar Spinal Fusion: Epidemiology, Risk Factors, and Associated Complications. World Neurosurg 2024:S1878-8750(24)01579-1. [PMID: 39270782 DOI: 10.1016/j.wneu.2024.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 09/04/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Postoperative delirium (POD) is frequently reported in the elderly after major surgery. Several risk factors have been identified, including age, surgical complexity, and comorbidities. METHODS Posterior lumbar fusion patients were identified using PearlDiver and filtered into two cohorts based on the presence or absence of POD within 7 days of surgery. Epidemiological analyses were performed to examine trends in POD by age and year. Comparative analyses were performed on patient demographics and baseline cognitive status. After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analyzed. RESULTS Among 476,482 no POD and 2591 POD patients, the mean age was 60.90 years, 57.6% were female, and the mean Charlson comorbidity index was 1.78. POD patients frequently had baseline cognitive impairment (P < 0.001). Incidence of POD decreased from 0.7% in 2010 to 0.4% in 2022 (P < 0.001) and increased with increasing patient age (P < 0.001). POD patients had higher length of stay (12 vs. 6 days, P < 0.001) and 90-day costs ($20,605 vs. $17,849, P < 0.001). After matching, POD patients had higher hypernatremia (5.8% vs. 3.5%, P = 0.001) and hypocalcemia (5.0% vs. 3.5%, P = 0.026). POD patients had higher 90-day postoperative complications (P < 0.05) than no POD patients. CONCLUSIONS Nearly 0.5% of patients who underwent posterior spinal fusion between 2010 and 2022 developed delirium, although incidence rates have decreased over time. POD was common in elderly patients with electrolyte disturbances who underwent multilevel fusions. Patients suffering from POD had higher rates of 90-day postoperative complications. Ongoing efforts to deliver interventions to mitigate the consequences of POD among spine surgery patients are warranted.
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Affiliation(s)
- Ashley Knebel
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Manjot Singh
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Rhea Rasquinha
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Mohammad Daher
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Joseph E Nassar
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - John Hanna
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA
| | - Bassel G Diebo
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University, Providence, Rhode Island, USA.
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12
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Fu W, Li Y, Liu R, Li J. Incidence and Risk Factors of Delirium Following Brain Tumor Resection: A Retrospective National Inpatient Sample Database Study. World Neurosurg 2024; 189:e533-e543. [PMID: 38936612 DOI: 10.1016/j.wneu.2024.06.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the occurrence and factors predisposing to delirium following brain tumor resection. METHODS Data from patients who underwent brain tumor resection surgery from 2016 to 2019 were extracted from the National Inpatient Sample database and retrospectively analyzed. The difference between the 2 groups was compared by Wilcoxon rank test or χ2 test was used. Univariate and multivariate logistic regression analyses were used to identify the risk factors of delirium after brain tumor resection. RESULTS From 2016 to 2019, 28,340 patients who underwent brain tumor resection were identified in the National Inpatient Sample database, with the incidence of delirium being 4.79% (1357/28,340). It was found that increased incidence of delirium was significantly associated with age over 75 years and males (all P < 0.001). Besides, patients with delirium were more likely to have multiple comorbidities and to receive elective surgery (all P < 0.001). The results of logistic regression analysis showed that self-pay (odds ratio [OR] = 0.51; confidence interval [CI] = 0.31-0.83; P = 0.007), elective admission (OR = 0.53; CI = 0.47-0.60; P < 0.001), obesity (OR = 0.77; CI = 0.66-0.92; P = 0.003), females (OR = 0.79; CI = 0.71-0.88; P < 0.001), and private insurance (OR = 0.80; CI = 0.67-0.95; P = 0.012) were associated with lower occurrence of delirium. Besides, delirium was related to extra total hospital charges (P < 0.001), increased length of stay (P < 0.001), higher inpatient mortality (P = 0.001), and perioperative complications (including heart failure, acute renal failure, urinary tract infection, urinary retention, septicemia, pneumonia, blood transfusion, and cerebral edema) (P < 0.001). CONCLUSIONS Many factors were associated with the occurrence of delirium after brain tumor resection. Therefore, clinicians should identify high-risk patients prone to delirium in a timely manner and take effective management measures to reduce adverse outcomes.
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Affiliation(s)
- Wei Fu
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yi Li
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Rui Liu
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jingjing Li
- Department of Neurosurgery, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China.
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13
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Peng Z, Wu J, Wang Z, Xie H, Wang J, Zhang P, Yang Q, Luo Y. Incidence and related risk factors for postoperative delirium following revision total knee arthroplasty: a retrospective nationwide inpatient sample database study. BMC Musculoskelet Disord 2024; 25:633. [PMID: 39118027 PMCID: PMC11313129 DOI: 10.1186/s12891-024-07757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 08/05/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common surgical complication. However, the incidence and risk factors associated with postoperative delirium after revision total knee arthroplasty (rTKA) have not been comprehensively explored through extensive national databases. METHODS Utilizing the National Inpatient Sample (NIS), the largest comprehensive U.S. hospital healthcare database, we undertook a retrospective investigation involving 127,400 patients who underwent rTKA between 2010 and 2019. We assessed various aspects, including patient demographics, hospital characteristics, pre-existing medical conditions, and perioperative complications. RESULTS The overall incidence of postoperative delirium (POD) in patients undergoing rTKA between 2010 and 2019 was 0.97%. The highest incidence rate of 1.31% was recorded in 2013. Notably, this patient cohort demonstrated advanced age, increased burden of co-morbidities, prolonged hospital stays, increased hospitalization costs, and elevated in-hospital mortality rates (P < 0.001). Moreover, non-elective admissions, non-private insurance payments, and a preference for teaching hospitals were commonly observed among these patients. During their hospitalization, individuals who developed delirium subsequent to rTKA were more prone to experiencing certain perioperative complications. These complications encompassed medical issues like acute myocardial infarction, continuous invasive mechanical ventilation, postoperative shock, sepsis, stroke and other medical problems. Additionally, surgical complications including hemorrhage / seroma / hematoma, irrigation and debridement, prosthetic joint infection, periprosthetic fracture, and wound dehiscence / nonunion were noted. Several risk factors were found to be linked with the development of POD. These included advanced age (≥ 75 years), alcohol abuse, coagulation disorders, congestive heart failure, depression, fluid and electrolyte imbalances, and more. Conversely, female sex, having private insurance, and undergoing elective hospitalization emerged as protective factors against POD. CONCLUSION Our findings suggest that the general prevalence of POD in rTKA is relatively low according to NIS. There was a significant connection between the POD of rTKA and advanced age, prolonged length of stay (LOS), more in-patients' costs, higher in-hospital mortality rate, increased comorbidities, postoperative medical complications and postoperative surgical complications. This study helps to understand the risk factors associated with POD to improve poor outcomes.
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Affiliation(s)
- Zikai Peng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Jingyi Wu
- Department of Orthopedics, General Hospital of Southern Theater Command, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhennan Wang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hao Xie
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Ping Zhang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Ya Luo
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China.
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Richardson SJ, Cropp AD, Ellis SW, Gibbon J, Sayer AA, Witham MD. The interrelationship between multiple long-term conditions (MLTC) and delirium: a scoping review. Age Ageing 2024; 53:afae120. [PMID: 38965032 PMCID: PMC11223896 DOI: 10.1093/ageing/afae120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Delirium and multiple long-term conditions (MLTC) share numerous risk factors and have been shown individually to be associated with adverse outcomes following hospitalisation. However, the extent to which these common ageing syndromes have been studied together is unknown. This scoping review aims to summarise our knowledge to date on the interrelationship between MLTC and delirium. METHODS Searches including terms for delirium and MLTC in adult human participants were performed in PubMed, EMBASE, Medline, Psycinfo and CINAHL. Descriptive analysis was used to summarise findings, structured according to Synthesis Without Meta-analysis reporting guidelines. RESULTS After removing duplicates, 5256 abstracts were screened for eligibility, with 313 full-texts sought along with 17 additional full-texts from references in review articles. In total, 140 met inclusion criteria and were included in the final review. Much of the literature explored MLTC as a risk factor for delirium (n = 125). Fewer studies explored the impact of MLTC on delirium presentation (n = 5), duration (n = 3) or outcomes (n = 6) and no studies explored how MLTC impacts the treatment of delirium or whether having delirium increases risk of developing MLTC. The most frequently used measures of MLTC and delirium were the Charlson Comorbidity Index (n = 98/140) and Confusion Assessment Method (n = 81/140), respectively. CONCLUSION Existing literature largely evaluates MLTC as a risk factor for delirium. Major knowledge gaps identified include the impact of MLTC on delirium treatment and the effect of delirium on MLTC trajectories. Current research in this field is limited by significant heterogeneity in defining both MLTC and delirium.
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Affiliation(s)
- Sarah Joanna Richardson
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | | | - Jake Gibbon
- South Tyneside and Sunderland NHS Foundation Trust, South Shields, Tyne and Wear, UK
| | - Avan Aihie Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Miles David Witham
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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15
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Zhu W, Shen Y, Zhao H, Tang Y, Wang X, Li S. Predicting postoperative delirium after percutaneous transluminal angioplasty and stenting in patients with intracranial atherosclerotic stenosis. Neurol Res 2024:1-9. [PMID: 38909321 DOI: 10.1080/01616412.2024.2370730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 06/17/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE Known as a major surgical complication, postoperative delirium (POD) has not been well studied in patients with intracranial atherosclerotic stenosis (ICAS). This study aimed to investigate the correlation between perioperative clinical characteristics and the occurrence of POD. METHODS Patients' demographic characteristics and perioperative testing data were collected. Binary logistic regression was conducted for assessing related risk factors. A nomogram was developed to predict the occurrence of POD after percutaneous transluminal angioplasty and stenting (PTAS) in patients with ICAS. RESULTS The occurrence of POD in this study was 30.67%. Among all the clinical and laboratory characteristics in patients, age (OR = 1.234, 95%CI = 1.004-1.517, p = 0.046), gender (OR = 5.676, 95%CI = 1.028-31.334, p = 0.046), preoperative MMSE scores (OR = 2.298, 95%CI = 1.005-5.259, p = 0.049), the degree of stenosis (OR = 6.294, 95%CI = 1.043-37.974, p = 0.045), operating time (OR = 1.088, 95%CI = 1.023-1.157, p = 0.006), and HbA1c levels (OR = 2.226, 95%CI = 1.199-4.130, p = 0.011) were the independent risk factors. CONCLUSION Male patients with advanced-age, lower preoperative MMSE scores, severe stenosis, longer operating time, and higher HbA1c levels are closely related to POD after PTAS. Fully perioperative assessments may play an important role in predicting the occurrence of POD.
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Affiliation(s)
- Wanchun Zhu
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yiman Shen
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hua Zhao
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yinda Tang
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xuhui Wang
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shiting Li
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Aghajanian S, Shafiee A, Teymouri Athar MM, Mohammadifard F, Goodarzi S, Esmailpur F, Elsamadicy AA. Impact of Depression on Postoperative Medical and Surgical Outcomes in Spine Surgeries: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3247. [PMID: 38892958 PMCID: PMC11172961 DOI: 10.3390/jcm13113247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: The relationship between psychiatric disorders, including depression, and invasive interventions has been a topic of debate in recent literature. While these conditions can impact the quality of life and subjective perceptions of surgical outcomes, the literature lacks consensus regarding the association between depression and objective perioperative medical and surgical complications, especially in the neurosurgical domain. Methods: MEDLINE (PubMed), EMBASE, PsycINFO, and the Cochrane Library were queried in a comprehensive manner from inception until 10 November 2023, with no language restrictions, for citations investigating the association between depression and length of hospitalization, medical and surgical complications, and objective postoperative outcomes including readmission, reoperation, and non-routine discharge in patients undergoing spine surgery. Results: A total of 26 articles were considered in this systematic review. Upon pooled analysis of the primary outcome, statistically significantly higher rates were observed for several complications, including delirium (OR:1.92), deep vein thrombosis (OR:3.72), fever (OR:6.34), hematoma formation (OR:4.7), hypotension (OR:4.32), pulmonary embolism (OR:3.79), neurological injury (OR:6.02), surgical site infection (OR:1.36), urinary retention (OR:4.63), and urinary tract infection (OR:1.72). While readmission (OR:1.35) and reoperation (OR:2.22) rates, as well as non-routine discharge (OR:1.72) rates, were significantly higher in depressed patients, hospitalization length was comparable to non-depressed controls. Conclusions: The results of this review emphasize the significant increase in complications and suboptimal outcomes noted in patients with depression undergoing spinal surgery. Although a direct causal relationship may not be established, addressing psychiatric aspects in patient care is crucial for providing comprehensive medical attention.
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Affiliation(s)
- Sepehr Aghajanian
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj 3198764653, Iran; (S.A.); (F.E.)
- Neuroscience Research Center, Iran University of Medical Sciences, Tehran 14496-14535, Iran
| | - Arman Shafiee
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj 3198764653, Iran; (S.A.); (F.E.)
| | | | - Fateme Mohammadifard
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj 3198764653, Iran; (S.A.); (F.E.)
| | - Saba Goodarzi
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj 3198764653, Iran; (S.A.); (F.E.)
| | - Fatemeh Esmailpur
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj 3198764653, Iran; (S.A.); (F.E.)
| | - Aladine A. Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, USA
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17
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Liu R, Liu N, Suo S, Yang Q, Deng Z, Fu W, Wang M. Incidence and risk factors of postoperative delirium following hepatic resection: a retrospective national inpatient sample database study. BMC Surg 2024; 24:151. [PMID: 38745220 PMCID: PMC11092011 DOI: 10.1186/s12893-024-02436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common complication after major surgery and can cause a variety of adverse effects. However, no large-scale national database was used to assess the occurrence and factors associated with postoperative delirium (POD) following hepatic resection. METHODS Patients who underwent hepatic resection from 2015 to 2019 were screened using the International Classification of Diseases (ICD) 10th edition clinical modification code from the National Inpatient Sample (NIS) Database. Peri-operative factors associated with delirium were screened and underwent statistical analysis to identify independent predictors for delirium following hepatic resection. RESULTS A total of 80,070 patients underwent hepatic resection over a five-year period from 2015 to 2019. The overall occurrence of POD after hepatic resection was 1.46% (1039 cases), with a slight upward trend every year. The incidence of elective admission was 6.66% lower (88.60% vs. 81.94%) than that of patients without POD after hepatic resection and 2.34% (45.53% vs. 43.19%) higher than that of patients without POD in teaching hospitals (P < 0.001). In addition, POD patients were 6 years older (67 vs. 61 years) and comprised 9.27% (56.69% vs. 47.42%) more male patients (P < 0.001) compared to the unaffected population. In addition, the occurrence of POD was associated with longer hospitalization duration (13 vs. 5 days; P < 0.001), higher total cost ($1,481,89 vs. $683,90; P < 0.001), and higher in-hospital mortality (12.61% vs. 4.11%; P < 0.001). Multivariate logistic regression identified hepatic resection-independent risk factors for POD, including non-elective hospital admission, teaching hospital, older age, male sex, depression, fluid and electrolyte disorders, coagulopathy, other neurological disorders, psychoses, and weight loss. In addition, the POD after hepatic resection has been associated with sepsis, dementia, urinary retention, gastrointestinal complications, acute renal failure, pneumonia, continuous invasive mechanical ventilation, blood transfusion, respiratory failure, and wound dehiscence / non-healing. CONCLUSION Although the occurrence of POD after hepatic resection is relatively low, it is beneficial to investigate factors predisposing to POD to allow optimal care management and improve the outcomes of this patient population.
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Affiliation(s)
- Rui Liu
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, 730030, China
| | - Ningyuan Liu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Shanlian Suo
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, 730030, China
| | - Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Zhen Deng
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Wei Fu
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, 730030, China.
| | - Min Wang
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, 730030, China.
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Li X, Xie H, Liu S, Wang J, Shi Z, Yao Q, Yang Q, Li Q, Bao L. Analysis of the incidence and risk factors of blood transfusion in total knee revision: a retrospective nationwide inpatient sample database study. BMC Musculoskelet Disord 2024; 25:225. [PMID: 38509493 PMCID: PMC10953239 DOI: 10.1186/s12891-024-07331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE This study sought to determine the incidence and risk factors of blood transfusion among patients undergoing total knee revision (TKR) using a nationwide database. METHODS A retrospective data analysis was conducted based on the Nationwide Inpatient Sample (NIS), enrolling patients who underwent TKR from 2010 to 2019 with complete information. The patients were divided into two groups based on whether they received blood transfusion or not. The demographic characteristics (race, sex, and age), length of stay (LOS), total charge of hospitalization, hospital characteristics (admission type, insurance type, bed size, teaching status, location, and region of hospital), hospital mortality, comorbidities, and perioperative complications were analyzed. Finally, we conducted univariate and multivariate logistic regression to identify factors that were associated with TKR patients to require blood transfusion. RESULTS The NIS database included 115,072 patients who underwent TKR. Among them, 14,899 patients received blood transfusion, and the incidence of blood transfusion was 13.0%. There was a dramatic decrease in the incidence over the years from 2010 to 2019, dropping from 20.4 to 6.5%. TKR patients requiring transfusions had experienced longer LOS, incurred higher total medical expenses, utilized Medicare more frequently, and had increased in-hospital mortality rates (all P < 0.001). Independent predictors for blood transfusion included advanced age, female gender, iron-deficiency anemia, rheumatoid disease, chronic blood loss anemia, congestive heart failure, coagulopathy, uncomplicated diabetes, lymphoma, fluid and electrolyte disorders, metastatic carcinoma, other neurological diseases, paralysis, peripheral vascular disorders, pulmonary circulation disorders, renal failure, valvular disease, and weight loss. In addition, risk factors for transfusion in TKR surgery included sepsis, acute myocardial infarction, deep vein thrombosis, pulmonary embolism, gastrointestinal bleeding, heart failure, renal insufficiency, pneumonia, wound infection, lower limb nerve injury, hemorrhage/seroma/hematoma, wound rupture/non healing, urinary tract infection, acute renal failure, and postoperative delirium. CONCLUSIONS Our findings highlight the importance of recognizing the risk factors of blood transfusion in TKR to reduce the occurrence of adverse events.
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Affiliation(s)
- Xiaoyin Li
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Hao Xie
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Shuxia Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zhanjun Shi
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Qiaobing Yao
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Qiuhong Li
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Liangxiao Bao
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Chen Q, Zhu C, Ai Y, Wang J, Ding H, Luo D, Li Z, Song Y, Feng G, Liu L. Preoperative geriatric nutritional risk index is useful factor for predicting postoperative delirium among elderly patients with degenerative lumbar diseases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1055-1060. [PMID: 38341814 DOI: 10.1007/s00586-024-08142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE It is the first study to evaluate the predictive value of the geriatric nutritional risk index (GNRI) on postoperative delirium (POD) after transforaminal lumber interbody fusion (TLIF) in elderly patients with degenerative lumbar diseases. METHODS A retrospective study was conducted to assess the outcomes of TLIF surgery in elderly patients with lumbar degenerative disease between the years 2016 and 2022. Delirium was diagnosed by reviewing postoperative medical records during hospitalization, utilizing the Confusion Assessment Method. The geriatric nutritional risk index was calculated using the baseline serum albumin level and body weight. Multivariate logistic regression analysis was employed to identify the association between preoperative GNRI and postoperative delirium (POD). Additionally, a receiver operating characteristic curve was utilized to determine the optimal GNRI cutoff for predicting POD. RESULTS POD was observed in 50 of the 324 patients. The GNRI was visibly reduced in the delirium group. The mean GNRI was 93.0 ± 9.1 in non-delirium group and 101.2 ± 8.2 in delirium group. On multivariate logistic regression, Risk of POD increases significantly with low GNRI and was an independent factor in predicting POD following TLIF (OR 0.714; 95% CI 0.540-0.944; p = 0.018). On receiver operating characteristic curve, the area under curve (AUC) for GNRI was 0.738 (95% CI 0.660-0.817). The cutoff value for GNRI according to the Youden index was 96.370 (sensitivity: 66.0%, specificity: 70.4%). CONCLUSION Our study indicated that lower GNRI correlated significantly with POD after TLIF. Performing GNRI evaluation prior to TLIF may be an effective approach of predicting the risk for POD among elderly patients with degenerative lumbar diseases.
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Affiliation(s)
- Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Orthopaedics and Laboratory of Biological Tissue Engineering and Digital Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Youwei Ai
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Juehan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hong Ding
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Dun Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zheng Li
- Department of Neurosurgery, Hokkaido University, Sapporo, Japan
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Luo M, Wang D, Shi Y, Yi Q, Wang Z, Zhou B, Yang G, Chen J, Liang C, Wang H, Zeng X, Yang Y, Tan R, Xie Y, Chen J, Tang S, Huang J, Mei Z, Xiao Z. Risk factors of postoperative delirium following spine surgery: A meta-analysis of 50 cohort studies with 1.1 million participants. Heliyon 2024; 10:e24967. [PMID: 38322910 PMCID: PMC10844026 DOI: 10.1016/j.heliyon.2024.e24967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/11/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVES Postoperative delirium (POD) is considered to be a common complication of spine surgery. Although many studies have reported the risk factors associated with POD, the results remain unclear. Therefore, we performed a meta-analysis to identify risk factors for POD among patients following spinal surgery. METHODS We systematically searched the PubMed, Embase and the Cochrane Library for relevant articles published from 2006 to February 1, 2023 that reported risk factors associated with the incidence of POD among patients undergoing spinal surgery. The Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed, and random effects models were used to estimate pooled odds ratio (OR) estimates with 95 % confidence intervals (CIs) for each factor. The evidence from observational studies was classified according to Egger's P value, total sample size, and heterogeneity between studies. RESULTS Of 11,329 citations screened, 50 cohort studies involving 1,182,719 participants met the inclusion criteria. High-quality evidence indicated that POD was associated with hypertension, diabetes mellitus, cardiovascular disease, pulmonary disease, older age (>65 years), patients experiencing substance use disorder (take drug ≥1 month), cerebrovascular disease, kidney disease, neurological disorder, parkinsonism, cervical surgery, surgical site infection, postoperative fever, postoperative urinary tract infection, and admission to the intensive care unit (ICU). Moderate-quality evidence indicated that POD was associated with depression, American Society of Anesthesiologists (ASA) fitness grade (>II), blood transfusion, abnormal potassium, electrolyte disorder, length of stay, inability to ambulate and intravenous fluid volume. CONCLUSIONS Conspicuous risk factors for POD were mainly patient- and surgery-related. These findings help clinicians identify high-risk patients with POD following spinal surgery and recognize the importance of early intervention.
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Affiliation(s)
- Mingjiang Luo
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Di Wang
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yuxin Shi
- Department of Pediatric Dentistry, First Affiliated Hospital (Affiliated Stomatological Hospital) of Xinjiang Medical University, Urumqi 830054, China
| | - Qilong Yi
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Zhongze Wang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Beijun Zhou
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Gaigai Yang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Juemiao Chen
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Can Liang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Haoyun Wang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Xin Zeng
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yuxin Yang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Ridong Tan
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yudie Xie
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Jiang Chen
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Siliang Tang
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Jinshan Huang
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Zubing Mei
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
- Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
| | - Zhihong Xiao
- The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
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Zhang A, Chen J, Zhang X, Jiang T, Li D, Cai X, Wang H, Ding W. Twelfth thoracic vertebra erector spinae plane block for postoperative analgesia and early recovery after lumbar spine surgery in elderly patients: a single-blind randomized controlled trial. BMC Anesthesiol 2023; 23:402. [PMID: 38062374 PMCID: PMC10701994 DOI: 10.1186/s12871-023-02351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Severe pain after lumbar spine surgery can delay recovery in elderly patients. We explored the efficacy of T12 erector spinal plane block (ESPB) in elderly patients who underwent lumbar spine surgery. METHODS A total of 230 patients undergoing lumbar spine surgery were divided and randomly allocated to ultrasound-guided ESPB (n = 115) and control (n = 115) groups. The ESPB group received 20 mL of 0.4% ropivacaine bilaterally at the T12 level after intubation, whereas the control group did not receive a block. The primary outcome was the numeric rating scale (NRS) score at 12 h after surgery. Secondary outcomes included the NRS score and tramadol use within 72 h postoperatively, intraoperative remifentanil use, incidence of postoperative delirium (POD), complications of ESPB, ambulation time, and length of hospitalization after surgery. RESULTS The12-hour NRS (median (IQR)) score was remarkably lower in the ESPB group than in the control group (2 (1-3) vs. 3 (2-4), p = 0.004), as well as NRS score within 48 h (P < 0.01). The ESPB group had less intraoperative remifentanil use (P < 0.001), and less tramadol use within 72 h postoperatively (P < 0.001). Seven patients (6.7%) developed POD in the ESPB group and ten patients (9.3%) in the control group, without any statistically significant difference (P > 0.05). The ambulation time and length of hospitalization after surgery were shorter in the ESPB group than in the control group (P < 0.05). No ESPB-related complications were observed. CONCLUSIONS Bilateral T12 ESPB lowered the NRS score within 48 h after lumbar spine surgery, decreased perioperative opioid use and resulted in faster recovery in elderly patients but did not significantly reduce the incidence of POD. TRIAL REGISTRATION The study was retrospectively registered at www.chictr.org.cn (ChiCTR2100042037) on January 12, 2021.
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Affiliation(s)
- Aijia Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China
| | - Jiaxin Chen
- Department of Anesthesiology, Women's Hospital of Zhejiang University, Hangzhou, Zhejiang, China
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China
| | - Xiaoyun Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China
| | - Tao Jiang
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China
| | - Dongmei Li
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China
| | - Xuemin Cai
- Department of Anesthesiology, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Haixu Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China
| | - Wengang Ding
- Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, Heilongjiang, 150086, Heilongjiang, China.
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Piccirillo A, Perri F, Vittori A, Ionna F, Sabbatino F, Ottaiano A, Cascella M. Evaluating Nutritional Risk Factors for Delirium in Intensive-Care-Unit Patients: Present Insights and Prospects for Future Research. Clin Pract 2023; 13:1577-1592. [PMID: 38131687 PMCID: PMC10742123 DOI: 10.3390/clinpract13060138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Malnutrition, hypercatabolism, and metabolic changes are well-established risk factors for delirium in critically ill patients. Although the exact mechanisms are not fully understood, there is mounting evidence suggesting that malnutrition can cause a variety of changes that contribute to delirium, such as electrolyte imbalances, immune dysfunction, and alterations in drug metabolism. Therefore, a comprehensive metabolic and malnutrition assessment, along with appropriate nutritional support, may help to prevent or ameliorate malnutrition, reduce hypercatabolism, and improve overall physiological function, ultimately lowering the risk of delirium. For this aim, bioelectrical impedance analysis can represent a valuable strategy. Further research into the underlying mechanisms and nutritional risk factors for delirium is crucial to developing more effective prevention strategies. Understanding these processes will allow clinicians to personalize treatment plans for individual patients, leading to improved outcomes and quality of life in the intensive-care-unit survivors.
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Affiliation(s)
- Arianna Piccirillo
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Francesco Perri
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Franco Ionna
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | | | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Abdominal Oncology, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, 80131 Naples, Italy;
| | - Marco Cascella
- Unit of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Department of Medicine, Surgery, and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081 Baronissi, Italy
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Lee SS, Kim JH, Lee JJ, Kwon YS, Seo EM. The Impact of Blood Transfusion in Developing Postoperative Delirium in Patients with Hip Fracture Surgery. J Clin Med 2023; 12:4696. [PMID: 37510810 PMCID: PMC10380490 DOI: 10.3390/jcm12144696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Many studies have been conducted to explore the risk factors associated with postoperative delirium (POD) in order to understand its underlying causes and develop prevention strategies, especially for hip fracture surgery. However, the relationship between blood transfusion and POD has been heatedly debated. The purpose of this study was to evaluate the risk factors of POD and the relationship between blood transfusions and the occurrence of POD in hip fracture surgery through big data analysis. METHODS Medical data (including medication history, clinical and laboratory findings, and perioperative variables) were acquired from the clinical data warehouse (CDW) of the five hospitals of Hallym University Medical Center and were compared between patients without POD and with POD. RESULTS The occurrence of POD was 18.7% (228 of 2398 patients). The risk factors of POD included old age (OR 4.38, 95% CI 2.77-6.91; p < 0.001), American Society of Anesthesiology physical status > 2 (OR 1.84 95% CI 1.4-2.42; p < 0.001), dementia (OR 1.99, 95% CI 1.53-2.6; p < 0.001), steroid (OR 0.53 95% CI 0.34-0.82; p < 0.001), Antihistamine (OR 1.53 95% CI 1.19-1.96; p < 0.001), and postoperative erythrocyte sedimentation rate (mm/h) (OR 0.97 95% CI 0.97-0.98; p < 0.001) in multivariate logistic regression analysis. The postoperative transfusion (OR 2.53, 95% CI 1.88-3.41; p < 0.001) had a significant effect on the incidence of POD. CONCLUSIONS big data analytics using a CDW was a good option to identify the risk factors of POD and to prevent POD in hip fracture surgery.
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Affiliation(s)
- Sang-Soo Lee
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| | - Jong-Ho Kim
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| | - Jae-Jun Lee
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| | - Young-Suk Kwon
- Division of Big Data and Artificial Intelligence, Institute of New Frontier Research, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| | - Eun-Min Seo
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
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Karageorgos V, Mevorach L, Silvetti M, Bilotta F. Preoperative Risk Factors Associated with Increased Incidence of Postoperative Delirium: Systematic Review of Qualified Clinical Studies. Geriatrics (Basel) 2023; 8:24. [PMID: 36826366 PMCID: PMC9956273 DOI: 10.3390/geriatrics8010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/20/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Postoperative delirium (POD) is an acute alteration of mental state, characterized by reduced awareness and attention, occurring up to five postoperative days after recovery from anesthesia. Several original studies and reviews have identified possible perioperative POD risk factors; however, there is no comprehensive review of the preoperative risk factors in patients diagnosed with POD using only validated diagnostic scales. The aim of this systematic review was to report the preoperative risk factors associated with an increased incidence of POD in patients undergoing non-cardiac and non-brain surgery. The reviewed studies included original research papers that used at least one validated diagnostic scale to identify POD occurrence for more than 24 h. A total of 6475 references were retrieved from the database search, with only 260 of them being suitable for further review. Out of the 260 reviewed studies, only 165 that used a validated POD scale reported one or more preoperative risk factors. Forty-one risk factors were identified, with various levels of statistical significance. The extracted risk factors could serve as a preoperative POD risk assessment workup. Future studies dedicated to the further evaluation of the specific preoperative risk factors' contributions to POD could help with the development of a weighted screening tool.
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Affiliation(s)
| | - Lior Mevorach
- Department of Anesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Melissa Silvetti
- Department of Anesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, 00185 Rome, Italy
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Yang Q, Fu J, Pan X, Shi D, Li K, Sun M, Ding J, Shi Z, Wang J. A retrospective analysis of the incidence of postoperative delirium and the importance of database selection for its definition. BMC Psychiatry 2023; 23:88. [PMID: 36747159 PMCID: PMC9900975 DOI: 10.1186/s12888-023-04576-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/27/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common complication after major surgery, resulting in various adverse reactions. However, incidence and risk factors associated with POD after shoulder arthroplasty (SA) have not been well studied using a large-scale national database. METHODS A retrospective database analysis was performed based on the Nationwide Inpatient Sample (NIS) from 2005 to 2014, the largest fully paid hospital care database in the United States. Patients undergoing SA were included. The patient's demographics, comorbidities, length of stay (LOS), total costs, type of insurance, type of hospital, in-hospital mortality, and medical and surgical perioperative complications were assessed. RESULTS A total of 115,147 SA patients were obtained from the NIS database. The general incidence of delirium after SA was 0.89%, peaking in 2010. Patients with delirium after SA had more comorbidities, prolonged LOS, increased hospitalization costs, and higher in-hospital mortality (P < 0.0001). These patients were associated with medical complications during hospitalization, including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, urinary tract infection, sepsis, continuous invasive mechanical ventilation, blood transfusion, and overall perioperative complications. Risk factors associated with POD include advanced age, neurological disease, depression, psychosis, fluid and electrolyte disturbances, and renal failure. Protective factors include elective hospital admissions and private insurance. CONCLUSION The incidence of delirium after SA is relatively low. Delirium after SA was associated with increased comorbidities, LOS, overall costs, Medicare coverage, mortality, and perioperative complications. Studying risk factors for POD can help ensure appropriate management and mitigate its consequences. Meanwhile, we found some limitations of this type of research and the need to establish a country-based POD database, including further clearly defining the diagnostic criteria for POD, investigating risk factors and continuing to collect data after discharge (30 days or more), so as to further improve patient preoperative optimization and management.
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Affiliation(s)
- Qinfeng Yang
- grid.284723.80000 0000 8877 7471Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515 Guangdong China
| | - Jinlang Fu
- grid.284723.80000 0000 8877 7471Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515 Guangdong China
| | - Xin Pan
- grid.284723.80000 0000 8877 7471Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515 Guangdong China
| | - Danping Shi
- grid.284723.80000 0000 8877 7471Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Kunlian Li
- Beijing Goodwill Hessian Health Technology Co., Ltd, Gehua Tower, No.1 Qinglong Hutong, Dongcheng District, Beijing, 100007 China
| | - Min Sun
- Beijing Goodwill Hessian Health Technology Co., Ltd, Gehua Tower, No.1 Qinglong Hutong, Dongcheng District, Beijing, 100007 China
| | - Jie Ding
- Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Zhanjun Shi
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
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Wang SK, Cui P, Wang DF, Wang P, Kong C, Lu SB. Preoperative Zung depression scale predicts outcomes in older patients undergoing short-segment fusion surgery for degenerative lumbar spinal disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:718-726. [PMID: 36562871 DOI: 10.1007/s00586-022-07497-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To identify the relationship between depression measured by Zung depression rating scale (ZDRS) and postoperative outcomes (including the patients reported outcomes [PRO] and clinical outcomes) two years after short-segment fusion surgery for degenerative lumbar spinal disease in older patients (aged 75 years and older). METHODS We enrolled patients who underwent short-segment fusion surgery for lumbar degenerative disease from May 2018 to June 2020. All patients were assessed for depression using the ZDRS. Patients were included in the depression group and not-depressed group based on their scores. Preoperative baseline data were collected on characteristics, comorbidities, laboratory data, pain levels (visual analogue scale [VAS]), functional status (Oswestry Disability Index [ODI]), and surgery-related variables. The primary outcomes were PRO measures, including VAS, ODI and satisfaction two years after lumbar fusion surgery. Other outcomes included postoperative complications, the length of stay, and reoperation. Univariate and multivariate analyses were performed to identify the risk factors for poor satisfaction. RESULTS A total of 231 patients (201 in not-depressed and 30 in depressed group) were enrolled in this study. There were no significant differences between the two groups for baseline data. Depressed group had higher rates of choices for dissatisfaction (36.7% vs. 14.0%, p = 0.015), higher VAS scores of low back pain (2.8 ± 2.3 vs. 1.6 ± 1.7, p = 0.012), and worse functional status (31.5 ± 22.5 vs 21.8 ± 19.9, p = 0.015) than the not-depressed group. Depressed patients reported significantly higher rates of postoperative complications and readmissions. Multivariate regression analysis revealed that depression (p = 0.001) was independently associated with postoperative dissatisfaction. CONCLUSION Preoperative depression was a risk factor for postoperative dissatisfaction, worse functional status, readmission, and complications in older patients undergoing lumbar fusion surgery. Preoperative screening using the Zung depression scale helps inform decision-making when considering fusion surgery for patients aged 75 and older.
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Affiliation(s)
- Shuai-Kang Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Peng Cui
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Dong-Fan Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Peng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China.
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Sica R, Wilson JM, Kim EJ, Culley DJ, Meints SM, Schreiber KL. The Relationship of Postoperative Pain and Opioid Consumption to Postoperative Delirium After Spine Surgery. J Pain Res 2023; 16:287-294. [PMID: 36744116 PMCID: PMC9891065 DOI: 10.2147/jpr.s380616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 01/22/2023] [Indexed: 01/29/2023] Open
Abstract
Purpose To examine the relationship between postoperative pain and opioid use and the development of postoperative delirium (POD), with attention to the preoperative opioid use status of patients. Methods This was a secondary analysis of data from a prospective observational study of patients (N = 219; ≥70 years old) scheduled to undergo elective spine surgery. Maximal daily pain scores (0-10) and postoperative morphine milligram equivalents per hour (MME/hr) were determined for postoperative days 1-3 (D1-3). POD was assessed by daily in-person interviews using the Confusion Assessment Method and chart review. Results Patients who reported regular preoperative opioid use (n = 58, 27%) reported significantly greater maximal daily pain scores, despite also requiring greater daily opioids (MME/hr) in the first 3 days after surgery. These patients were also more likely to develop POD. Interestingly, while postoperative pain scores were significantly higher in patients who developed POD, postoperative opioid consumption was not significantly higher in this group. Conclusion POD was associated with greater postoperative pain, but not with postoperative opioid consumption. While postoperative opioid consumption is often blamed for delirium, these findings suggest that uncontrolled pain may actually be a more important factor, particularly among patients who are opioid tolerant. These findings underscore the importance of employing multimodal perioperative analgesic management, especially among older patients who have a predilection to developing POD and baseline tolerance to opioids.
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Affiliation(s)
- Ryan Sica
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Correspondence: Ryan Sica, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA, Tel +1 617 732-8210, Email
| | - Jenna M Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Erin J Kim
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Deborah J Culley
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Samantha M Meints
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Zhang X, Qi S, Lin Z, Zhang Y, Dai W, Tian W, Tian J, Zheng L, Su D, Huai X. Pre-operative administration of butorphanol mitigates emergence agitation in patients undergoing functional endoscopic sinus surgery: A randomized controlled clinical trial. Front Psychiatry 2023; 13:1090149. [PMID: 36733413 PMCID: PMC9887110 DOI: 10.3389/fpsyt.2022.1090149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
Background This study explored the effectiveness of pre-operative intravenous injection of butorphanol in the alleviation of emergence agitation (EA) in patients undergoing functional endoscopic sinus surgery (FESS). Methods Patients (n = 708) were randomized into two groups. The butorphanol group (Group B, n = 358) received butorphanol infusion (20 ug/kg) before anesthesia induction, while the control group (Group C, n = 350) received an equal volume of normal saline infusion. General anesthesia was induced with sufentanil, propofol, and rocuronium, and was maintained with sevoflurane and remifentanil. Vasoactive drugs maintained the hemodynamic indices within 20% of the baseline. Results The incidence of EA was significantly lower in Group B than that in Group C (Group B vs. C: 24.3% vs. 31.4%, respectively; P = 0.034). The times to spontaneous breathing (26.5 min vs. 23.7 min, P = 0.011), verbal response (36.0 min vs. 33.4 min, P = 0.012), and extubation (31.0 min vs. 28.7 min, P = 0.025) were longer in Group B, and the grade of cough (0.33 vs. 0.43, P = 0.024) at extubation in Group B was lower than that in Group C (P = 0.024). The mean arterial pressure at the end of the operation (P = 0.004) and at 5 min after extubation (P = 0.008) was higher and hypotension was less prominent (0.6% vs. 2.6%, P = 0.030) in Group B. Conclusion Pre-operative intravenous injection of butorphanol decreased the incidence of EA after FESS and provided smooth and hemodynamically stable emergence without extending the stay in post-anesthesia care unit. Clinical trial registration https://www.clinicaltrials.gov/, identifier NCT03398759.
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Affiliation(s)
- Xiao Zhang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Siyi Qi
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Lin
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Yizhe Zhang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wanbing Dai
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weitian Tian
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Tian
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Zheng
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Diansan Su
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaorong Huai
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Sircar K, Yagdiran A, Bredow J, Annecke T, Eysel P, Scheyerer MJ. The influence of orthopedic surgery on the incidence of post-operative delirium in geriatric patients: results of a prospective observational study. J Clin Orthop Trauma 2022; 33:102000. [PMID: 36061969 PMCID: PMC9437901 DOI: 10.1016/j.jcot.2022.102000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 06/16/2022] [Accepted: 08/22/2022] [Indexed: 01/28/2023] Open
Abstract
Background Postoperative delirium (PD) is a major concern in geriatric patients undergoing orthopedic surgery. This prospective observational study aims to examine the incidence of PD, to identify intervention-specific risk factors and to investigate the influence of orthopedic surgery on delirium. Methods From 2019 to 2020, 132 patients ≥70 years of age with endoprosthetic (Group E) or spinal surgery (Group S) were included. Upon admission, the ISAR score, the Nursing Delirium Screening Scale, potential risk factors, the ASA score, duration of surgery, type of anesthesia, blood loss, and hemoglobin drop were recorded. For risk factor analysis patients were grouped into Group D (delirium) and Group ND (no delirium). Primary endpoint was the occurrence of PD. Results Of 132 patients, 50 were included in Group E and 82 in Group S. Mean age and ISAR score were not significantly different between groups. Delirium rate in Group E and S was 12% vs. 18% (p = 0.3). Differences could be observed between Group D and ND in duration of surgery (173 min vs. 112 min, p = 0.02), postoperative hemoglobin drop (3.2 g/dl vs. 2.3 g/dl; p = 0.026), history of PD (23% vs. 11%, p = 0.039) and use of isoflurane (6 vs. 2). Type of surgery was not an independent risk factor (p = 0.26). Conclusion Specific type of orthopedic surgery is not an independent risk factor for PD. Prevention of PD should focus on duration of surgery and blood loss, particularly in patients with a history of PD. A possible delirogenic potential of isoflurane should be further studied.
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Affiliation(s)
- Krishnan Sircar
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener-Strasse 62, 50937 Cologne, Germany
| | - Ayla Yagdiran
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener-Strasse 62, 50937 Cologne, Germany
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener-Strasse 62, 50937 Cologne, Germany
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Urbacher Weg 19, 51149 Cologne, Germany
| | - Thorsten Annecke
- Department of Anesthesiology and Intensive Care Medicine, Krankenhaus Köln-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener-Strasse 62, 50937 Cologne, Germany
| | - Max Joseph Scheyerer
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener-Strasse 62, 50937 Cologne, Germany
- Department of Orthopedics and Trauma Surgery, University Hospital of Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
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Wang JH, Lv M, Zhang HX, Gao Y, Chen TT, Wan TT, Wang YL. Impact of propofol versus sevoflurane on the incidence of postoperative delirium in elderly patients after spine surgery: study protocol of a randomized controlled trial. Trials 2022; 23:720. [PMID: 36042484 PMCID: PMC9426016 DOI: 10.1186/s13063-022-06687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background Postoperative delirium in elderly patients is a common and costly complication after surgery. Propofol and sevoflurane are commonly used anesthetics during general anesthesia, and the sedative and anti-inflammatory mechanisms of the two medications are different. The aim of this trial is to compare the impact of propofol with sevoflurane on the incidence of postoperative delirium in elderly patients after spine surgery. Methods A single-center randomized controlled trial will be performed at First Affiliated Hospital of Shandong First Medical University, China. A total of 298 participants will be enrolled in the study and randomized to propofol infusion or sevoflurane inhalation groups. The primary outcome is the incidence of delirium within 7 days after surgery. Secondary outcomes include the day of postoperative delirium onset, duration (time from first to last delirium-positive day), and total delirium-positive days among patients who developed delirium; tracheal intubation time in PACU; the length of stay in PACU; the rate of postoperative shivering; the rate of postoperative nausea and vomiting; the rate of emergence agitation; pain severity; QoR40 at the first day after surgery; the length of stay in hospital after surgery; and the incidence of non-delirium complications within 30 days after surgery. Discussion The primary objective of this study is to compare the impact of propofol and sevoflurane on the incidence of postoperative delirium for elderly patients undergoing spine surgery. The results may help inform strategies to the optimal selection of maintenance drugs for general anesthesia in elderly patients undergoing spine surgery. Trial registration ClinicalTrials.govNCT05158998. Registered on 14 December 2021
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Affiliation(s)
- Ji-Hua Wang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, 250000, Shandong, China
| | - Meng Lv
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, 250000, Shandong, China.
| | - Hai-Xia Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, 250000, Shandong, China
| | - Yang Gao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, 250000, Shandong, China.,Shandong First Medical University, Ji'nan, 250000, Shandong, China
| | - Ting-Ting Chen
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, 250000, Shandong, China.,Shandong First Medical University, Ji'nan, 250000, Shandong, China
| | - Tian-Tian Wan
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, 250000, Shandong, China
| | - Yue-Lan Wang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji'nan, 250000, Shandong, China.
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Sharma M, Jain N, Dietz N, Wang D, Ugiliweneza B, Drazin D, Boakye M. Incidence of New Onset Dementia and Health Care Utilization Following Spine Fusions: A Propensity Score Matching Analysis. Neurochirurgie 2022; 68:562-568. [PMID: 35932885 DOI: 10.1016/j.neuchi.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dementia following spine fusions is not described in the literature. Also, the impact of new onset dementia on long-term health care utilization is not described. The aim of our study was to define the incidence of new onset dementia and its long-term health care utilization in elderly patients. MATERIALS AND METHODS MarketScan database were queried using the ICD-9/10 and CPT 4th edition, from 2001 to 2019. We included patients ≥ 55 of age who underwent spine fusions with at least 5 years follow-up. Outcomes were new onset dementia (> 6 months after the procedure) length of stay (LOS), discharge disposition, hospital re-admissions, outpatient services, and medication refills. RESULTS Of 45,129 patients who underwent spine fusions, 1283 patients (2.84%) were diagnosed to have new-onset dementia. There was no difference in the re-operation rates among the dementia and non-dementia cohort at 1-, 2- and 5-years following the index procedure. Patients in the dementia cohort incurred higher number of hospital re-admissions up to 5-years after the index procedure. In terms of combined index procedure and post-discharge utilization payments, significant differences were noted among the dementia vs. non-dementia cohorts at 5-years ($126,628 vs. $ 77,098), following the index procedure. CONCLUSION Elderly age, higher comorbidities, Medicare insurance, multi-level lumbosacral fusions were identified as risk markers for developing dementia following spine fusions. Dementia resulted in significantly higher health care utilization with no increased rate of re-operations for up to 5-years following the index procedure.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A.
| | - Nikhil Jain
- Department of Orthopedics, Boston University Medical Center, Boston, MA 02118, U.S.A
| | - Nicholas Dietz
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A; Kentucky Spinal Cord Injury Research Center, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A; Kentucky Spinal Cord Injury Research Center, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A; Department of Health Management and Systems Sciences, University of Louisville, 485 E. Gray St, Louisville, KY 40202, U.S.A
| | - Doniel Drazin
- Evergreen Hospital Neuroscience Institute, 98034 Kirkland, WA, U.S.A
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A; Kentucky Spinal Cord Injury Research Center, University of Louisville, 200 Abraham Flexner Hwy, 40202 Louisville, KY, U.S.A
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Glacial Debris Flow Blockage Event (2018) in the Sedongpu Basin of the Yarlung Zangbo River, China: Occurrence Factors and Its Implications. LAND 2022. [DOI: 10.3390/land11081217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this paper, the glacial debris flow blockage event, on 17 October 2018, in the Sedongpu basin of the Yarlung Zangbo River is taken as an example to analyse the occurrence and development of glacier hazards in this region. Multi-sources including remote sensing products, DEM, earthquake records and meteorological data were used to analyse the characteristics and mechanism of glacier hazards. The Elmer/Ice dynamic model was chosen to simulate the glacial surface velocity. It was found that topography and climate background determine that the hazard happens periodically. Based on the meteorological records of the Linzhi station, the warming rate was greater than 0.40 °C/10a during the period 1960–2017. The short-term heavy rainfall with daily values of 9.3 mm before the blockage event was also regarded as a factor. Both heavy rain and earthquake were triggering factors of the ice avalanche that led to the glacial debris flow. The glacier surface velocity of the Dongpu glacier simulated by Elmer/Ice model can reach 19 cm/d. This study has extensive applicability significance in glacier hazard mitigation under a changing climate.
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Gold C, Ray E, Christianson D, Park B, Kournoutas IA, Kahn TA, Perez EA, Berger JI, Sander K, Igram CA, Pugely A, Olinger CR, Carnahan R, Chen PF, Mueller R, Hitchon P, Howard MA, Banks M, Sanders RD, Woodroffe RW. Risk factors for delirium in elderly patients after lumbar spinal fusion. Clin Neurol Neurosurg 2022; 219:107318. [PMID: 35750022 DOI: 10.1016/j.clineuro.2022.107318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify perioperative risk factors for postoperative delirium (POD) in patients aged 65 or older undergoing lumbar spinal fusion procedures. PATIENTS AND METHODS A retrospective cohort analysis was performed on patients undergoing lumbar spinal fusion over an approximately three-year period at a single institution. Demographic and perioperative data were obtained from electronic medical records. The primary outcome was the presence of postoperative delirium assayed by the Delirium Observation Screening Scale (DOSS) and Confusion Assessment Method for the ICU (CAM-ICU). Univariate and multivariate analyses were performed on the data. RESULTS Of the 702 patients included in the study, 173 (24.6%) developed POD. Our analysis revealed that older age (p < 0.001), lower preoperative hemoglobin (p < 0.001), and higher ASA status (p < 0.001), were significant preoperative risk factors for developing POD. The only significant intraoperative risk factor was a higher number of spinal levels that were instrumented (p < 0.001). Higher pain scores on postoperative day 1 (p < 0.001), and lower postoperative hemoglobin (p < 0.001) were associated with increased POD; as were ICU admission (p < 0.001) and increased length of ICU stay (p < 0.001). Patients who developed POD had a longer hospital stay (p < 0.001) with lower rates of discharge to home as opposed to an inpatient facility (p < 0.001). CONCLUSION Risk factors for POD in older adults undergoing lumbar spinal fusion surgery include advanced age, diabetes, lower preoperative and postoperative hemoglobin, higher ASA grade, greater extent of surgery, and higher postoperative pain scores. Patients with delirium had a higher incidence of postoperative ICU admission, increased length of stay, decreased likelihood of discharge to home and increased mortality, all consistent with prior studies. Further studies may determine whether adequate management of anemia and pain lead to a reduction in the incidence of postoperative delirium in these patients.
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Affiliation(s)
- Colin Gold
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Emanuel Ray
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - David Christianson
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Brian Park
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | | | - Taimur A Kahn
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Eli A Perez
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Joel I Berger
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Katie Sander
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Cassim A Igram
- Department of Orthopedic Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Andrew Pugely
- Department of Orthopedic Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Catherine R Olinger
- Department of Orthopedic Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Ryan Carnahan
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Pei-Fu Chen
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Rashmi Mueller
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Patrick Hitchon
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Matthew A Howard
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Matthew Banks
- Department of Anesthesiology University of Wisconsin, Madison, WI, USA
| | - Robert D Sanders
- Specialty of Anaesthetics, University of Sydney, Sydney, Australia; Department of Anaesthetics & Institute of Academic Surgery, Royal Prince Alfred Hospital, Australia
| | - Royce W Woodroffe
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Hydrogenation of Xylose to Xylitol in the Presence of Bimetallic Nanoparticles Ni3Fe Catalyst in the Presence of Choline Chloride. Catalysts 2022. [DOI: 10.3390/catal12080841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Hydrogenation of sugars to sugars alcohols is of prime interest for food applications for instance. Xylose obtained from the hemicellulose fraction of lignocellulosic biomass can be hydrogenated to xylitol. Herein, we conducted catalytic hydrogenation reactions in a non-conventional media approach by using choline chloride, a non-toxic naturally occurring organic compound that can form a deep eutectic solvent with xylose. Acknowledging the benefits of cost-effective transition metal-based alloys, Ni3Fe1 bimetallic nanoparticles were utilized as a hetero-catalyst. Under optimized reaction conditions (110 °C, 3 h and 30 bar H2), a highly concentrated feed of xylose (76 wt.%) was converted to 80% of xylitol, showing the benefit of using choline chloride. Overall, the catalytic conversion activity and the product selectivity in the substrate-assisted DES media are relatively high but, the recyclability of the catalyst should be improved in the presence of such media.
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Titanite Spectroscopy and In Situ LA-ICP-MS U–Pb Geochronology of Mogok, Myanmar. CRYSTALS 2022. [DOI: 10.3390/cryst12081050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
With the development of mineral testing technology and ore deposit geochemistry, titanite has become a hot topic in the study of accessory minerals. Two large-grained titanite crystals from Mogok, Myanmar, were used for a detailed study. In this study, the standard gemmological properties and spectral characteristics of titanite crystals were obtained by Fourier transform in-frared, micro ultraviolet-visible-near-infrared and Raman spectroscopy, respectively, which pro-vide a full set of data. Mineral major and trace elements were analysed using Electron-Probe Mi-croAnalysis (EPMA) and Laser Ablation Inductively Coupled Plasma Mass Spectrometry (LA-ICP-MS). The purpose of this study is to report spectral characteristics and major and trace elements of Mogok, Myanmar, in order to find new potential titanite standard samples. The two titanite crystals have similar major element compositions, and both grains have relatively low Al content (0.011–0.014 apfu) and Al/Fe ratios (0.157–0.222), but high Fe content (0.063–0.079 apfu). The two titanite crystals have similar chondrite-normalised rare earth element (REE) patterns with significantly Light Rare Earth Element (LREE) (La–Gd) enrichment and deletion of Heavy Rare Earth Element (HREE) (Tb–Lu). The 238U/206Pb ages of the two titanite samples are 43.5 ± 5.8 Ma and 34.0 ± 4.2 Ma, respectively. Generally, magmatic titanite has a low Al/Fe ratio, metamorphic and hydrothermal titanite crystals have extremely low Th/U ratios close to zero, with flat chondrite-normalised REE patterns or depletions in light REEs relative to heavy REEs. Different genetic types of titanite can be distinguished by the characteristics of major and trace elements. Combined chemical features such as REE differentiation, Al/Fe and Th/U ratios with formation temperature, the analysed titanite samples are considered magmatic-hydrothermal titanites. Their 238U/206Pb ages may indicate a potential stage of magmatic hydrothermal conversion.
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Multi-Objective Energy Efficient Adaptive Whale Optimization Based Routing for Wireless Sensor Network. ENERGIES 2022. [DOI: 10.3390/en15145237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
In Wireless Sensor Networks (WSNs), routing algorithms can provide energy efficiency. However, due to unbalanced energy consumption for all nodes, the network lifetime is still prone to degradation. Hence, energy efficient routing was developed in this article by selecting cluster heads (CH) with the help of adaptive whale optimization (AWOA) which was used to reduce time-consumption delays. The multi-objective function was developed for CH selection. The clusters were then created using the distance function. After establishing groupings, the supercluster head (SCH) was selected using the benefit of a fuzzy inference system (FIS) which was used to collect data for all CHs and send them to the base station (BS). Finally, for the data-transfer procedure, hop count routing was used. An Oppositional-based Whale optimization algorithm (OWOA) was developed for multi-constrained QoS routing with the help of AWOA. The performance of the proposed OWOA methodology was analyzed according to the following metrics: delay, delivery ratio, energy, NLT, and throughput and compared with conventional techniques such as particle swarm optimization, genetic algorithm, and Whale optimization algorithm.
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Blockchain-Enabled Smart Grid Applications: Architecture, Challenges, and Solutions. SUSTAINABILITY 2022. [DOI: 10.3390/su14148801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The conventional electrical grid is undergoing substantial growth for reliable grid operation and for more efficient and sustainable energy use. The traditional grid is now metamorphosing into a smart grid (SG) that incorporates a diverse, heterogeneous blend of operating measures such as smart appliances, meters, and renewable energy resources. With better efficient results and dependability, the SG can be described as a modern electric power grid architecture. The SG is one of the greatest potential advances as a promising solution for the energy crisis. However, it is complex and its decentralization could be of tremendous benefit. Moreover, digitalization and integration of a large number of growing connections make it a target of cyber-attacks. In this sense, blockchain is a promising SG paradigm solution that offers several excellent features. There has been considerable effort put into using blockchains in the smart grid for its decentralization and enhanced cybersecurity; however, it has not been thoroughly studied in both application and architectural perspectives. An in-depth study was conducted on blockchain-enabled SG applications. Blockchain architectures for various applications, such as the synchrophasor applications, electric vehicles, energy management systems, etc., were proposed. The purpose of this article is to provide directions for future research efforts aimed at secure and decentralized SG applications using blockchain.
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Liu C, Liu J, Shao W, Lu J, Gao H. The Considerable Water Evaporation Induced by Human Perspiration and Respiration in Megacities: Quantifying Method and Case Study in Beijing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148638. [PMID: 35886494 PMCID: PMC9324489 DOI: 10.3390/ijerph19148638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022]
Abstract
The water cycle in urban areas is called the natural-social dualistic water cycle, and it is driven not only by natural forces, but also by human activities. As the drivers of the social water cycle, human perspire continuously, and this is often overlooked as a contributing factor to the water cycle. This paper proposes a method for quantifying the water evaporation induced by human perspiration and respiration in megacities. A calculation based on the sweating prediction model was applied to the city of Beijing to evaluate the evaporation from the human body. The results show that the greatest volume of evaporation produced by human occurs in summer, and the least in spring. The total evaporation produced by human was converted to the evaporation on unit area of the city and reached 5075.2 m3/km2 in the six core districts of Beijing. According to the calculation, the total volume was considerable and reached 14.0 million m3 in 2020, which was equivalent to the annual evapotranspiration from an area of 104.9 km2 of Acer truncatum forest (15 cm diameter at breast height, afforestation density 800 plants/hm2), and even twice the annual total water use in Tartu, Estonia. The results of the study provide a reference for dualistic water cycle research and water cycle flux calculation in urban areas.
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Affiliation(s)
- Chuang Liu
- State Key Laboratory of Simulation and Regulation of Water Cycle in River Basin, China Institute of Water Resources and Hydropower Research, Beijing 100038, China; (C.L.); (W.S.); (J.L.)
| | - Jiahong Liu
- State Key Laboratory of Simulation and Regulation of Water Cycle in River Basin, China Institute of Water Resources and Hydropower Research, Beijing 100038, China; (C.L.); (W.S.); (J.L.)
- Engineering and Technology Research Center for Water Resources and Hydroecology of the Ministry of Water Resources, Beijing 100038, China
- Key Laboratory of River Basin Digital Twinning of Ministry of Water Resources, Beijing 100038, China
- Correspondence: ; Tel.: +86-10-6878-1936
| | - Weiwei Shao
- State Key Laboratory of Simulation and Regulation of Water Cycle in River Basin, China Institute of Water Resources and Hydropower Research, Beijing 100038, China; (C.L.); (W.S.); (J.L.)
| | - Jiahui Lu
- State Key Laboratory of Simulation and Regulation of Water Cycle in River Basin, China Institute of Water Resources and Hydropower Research, Beijing 100038, China; (C.L.); (W.S.); (J.L.)
| | - Han Gao
- College of New Energy and Environment, Jilin University, Changchun 130021, China;
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Preoperative Inflammatory Markers and the Risk of Postoperative Delirium in Patients Undergoing Lumbar Spinal Fusion Surgery. J Clin Med 2022; 11:jcm11144085. [PMID: 35887857 PMCID: PMC9324332 DOI: 10.3390/jcm11144085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
We investigated the possible associations between postoperative delirium (POD) and routinely available preoperative inflammatory markers in patients undergoing lumbar spinal fusion surgery (LSFS) to explore the role of neuroinflammation and oxidative stress as risk factors for POD. We analyzed 11 years’ worth of data from the Smart Clinical Data Warehouse. We evaluated whether preoperative inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), and the CRP-to-albumin ratio (CAR), affected the development of POD in patients undergoing LSFS. Of the 3081 subjects included, 187 (7.4%) developed POD. A significant increase in NLR, MLR, and CAR levels was observed in POD patients (p < 0.001). A multivariate analysis showed that the second, third, and highest quartiles of the NLR were significantly associated with the development of POD (adjusted OR (95% CI): 2.28 (1.25−4.16], 2.48 (1.3−4.73], and 2.88 (1.39−5.96], respectively). A receiver operating characteristic curve analysis showed that the discriminative ability of the NLR, MLR, and CAR for predicting POD was low, but almost acceptable (AUC (95% CI): 0.60 (0.56−0.64], 0.61 (0.57−0.65], and 0.63 (0.59−0.67], respectively, p < 0.001). Increases in preoperative inflammatory markers, particularly the NLR, were associated with the development of POD, suggesting that a proinflammatory state is a potential pathophysiological mechanism of POD.
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Staartjes VE, Joswig H, Corniola MV, Schaller K, Gautschi OP, Stienen MN. Association of Medical Comorbidities With Objective Functional Impairment in Lumbar Degenerative Disc Disease. Global Spine J 2022; 12:1184-1191. [PMID: 33334183 PMCID: PMC9210248 DOI: 10.1177/2192568220979120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Analysis of a prospective 2-center database. OBJECTIVES Medical comorbidities co-determine clinical outcome. Objective functional impairment (OFI) provides a supplementary dimension of patient assessment. We set out to study whether comorbidities are associated with the presence and degree of OFI in this patient population. METHODS Patients with degenerative diseases of the spine preoperatively performed the timed-up-and-go (TUG) test and a battery of questionnaires. Comorbidities were quantified using the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiology (ASA) grading. Crude and adjusted linear regression models were fitted. RESULTS Of 375 included patients, 97 (25.9%) presented at least some degree of medical comorbidity according to the CCI, and 312 (83.2%) according to ASA grading. In the univariate analysis, the CCI was inconsistently associated with OFI. Only patients with low-grade CCI comorbidity displayed significantly higher TUG test times (p = 0.004). In the multivariable analysis, this effect persisted for patients with CCI = 1 (p = 0.030). Regarding ASA grade, patients with ASA = 3 exhibited significantly increased TUG test times (p = 0.003) and t-scores (p = 0.015). This effect disappeared after multivariable adjustment (p = 0.786 and p = 0.969). In addition, subjective functional impairment according to ODI, and EQ5D index was moderately associated with comorbidities according to ASA (all p < 0.05). CONCLUSION The degree of medical comorbidities appears only weakly and inconsistently associated with OFI in patients scheduled for degenerative lumbar spine surgery, especially after controlling for potential confounders. TUG testing may be valid even in patients with relatively severe comorbidities who are able to complete the test.
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Affiliation(s)
- Victor E. Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Holger Joswig
- Department of Neurosurgery, Health and Medical University Potsdam, Ernst von Bergmann Hospital, Potsdam, Germany
| | - Marco V. Corniola
- Department of Neurosurgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Oliver P. Gautschi
- Neuro- und Wirbelsäulenzentrum Zentralschweiz, Klinik St.Anna, Luzern, Switzerland
| | - Martin N. Stienen
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland,Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland,Martin N. Stienen, MD/FEBNS, Department of Neurosurgery, Kantonsspital St.Gallen, Rorschacher Str. 95, 9007 St.Gallen, Switzerland.
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Kim N, Kim TH, Oh JK, Lim J, Lee KU, Kim SW. Analysis of the Incidence and Risk Factors of Postoperative Delirium in Patients With Degenerative Cervical Myelopathy. Neurospine 2022; 19:323-333. [PMID: 35577342 PMCID: PMC9260543 DOI: 10.14245/ns.2142778.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Abstract
Objective The purpose of this study is to analyze various risk factors that can cause postoperative delirium (POD) in degenerative cervical myelopathy (DCM) patients, which may affect normal recovery and outcomes after surgery, and to help deal with them in advance and to take a medical approach.
Methods A total of 148 patients aged 60 years or older who underwent laminoplasty or anterior cervical discectomy and fusion (ACDF) for DCM from 2008 to 2015 were included in this study. Incidence and multiple risk factors for development of POD were analyzed.
Results POD occurred in 24 patients (16.2%). Among the 148 patients, 78 received laminoplasty, of whom 19 patients (24%) experienced delirium; the other 70 patients underwent ACDF, of whom 5 patients (7.1%) experienced delirium. History of Parkinson disease (odds ratio [OR], 178.242; p = 0.015), potassium level (OR, 3.764; p = 0.031), and surgical approach of laminoplasty over ACDF (OR, 8.538; p = 0.008) were found to be significant risk factors in a multivariate analysis. Age (OR, 1.056; p = 0.04) and potassium level (OR, 3.217; p = 0.04) were significant risk factors in the laminoplasty group.
Conclusion The findings of this study suggest that the incidence and risk factors for POD may vary in patients with DCM. It is necessary to understand multiple factors that affect the development of POD.
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Affiliation(s)
- Namhoo Kim
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Tae-Hwan Kim
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jae Keun Oh
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jeongsup Lim
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kang Uk Lee
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Seok Woo Kim
- Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
- Corresponding Author Seok Woo Kim Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongann-gu, Anyang 14068, Korea
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Wang W, Wang P, Kong C, Teng Z, Zhang S, Sun W, Lu S. Retrospective Data Analysis for Enhanced Recovery After Surgery (ERAS) Protocol for Elderly Patients with Long-Level Lumbar Fusion. World Neurosurg 2022; 164:e397-e403. [PMID: 35513281 DOI: 10.1016/j.wneu.2022.04.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) for spinal surgery is new; specifically, an ERAS program for elderly patients is lacking. Geriatric patients have special characteristics that result in further harm by surgical stress. ERAS interventions are designed to improve recovery after surgery and can result in substantial benefits in clinical outcomes and cost-effectiveness. We aimed to determine whether ERAS significantly improved satisfaction and outcomes in elderly patients with long-level lumbar fusion. METHODS Patients >70 years old with lumbar disc herniation or lumbar spinal stenosis who underwent lumbar fusion of ≥3 levels from July 2019 to June 2021 (ERAS group) and from January 2018 to June 2019 (non-ERAS group) were enrolled. Demographic, comorbidity, and surgical data were collected from electronic medical records. ERAS interventions were categorized as preoperative, intraoperative, and postoperative. We also evaluated primary outcome, surgical complications, and length of stay (LOS). RESULTS The study included 154 patients, 72 in the ERAS group and 82 case-matched patients in the non-ERAS group. Overall, ERAS pathway compliance was 91%. There were no significant differences in readmission and mortality rates at 30-day follow-up between the ERAS and non-ERAS groups. Statistically significant decreases were observed in the ERAS group in complications (6 in ERAS group vs. 19 in non-ERAS group, P = 0.013) and LOS (17.74 ± 5.56 days in ERAS group vs. 22.13 ± 12.21 days in non-ERAS group, P = 0.041). Multivariable linear regression showed that implementation of ERAS (P = 0.002) was correlated with LOS. Multivariable logistic regression showed that implementation of ERAS (P = 0.004) was correlated with complications. CONCLUSIONS The ERAS protocol used in elderly patients after long-level lumbar fusion surgery was safe and associated with incremental benefits regarding complications and LOS.
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Affiliation(s)
- Wei Wang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Peng Wang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Ze Teng
- Department of Radiology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Sitao Zhang
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Wenzhi Sun
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital of Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China; Beijing Municipal Geriatric Medical Research Center, Beijing, China.
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Rault F, Briant AR, Kamga H, Gaberel T, Emery E. Surgical management of lumbar spinal stenosis in patients over 80: is there an increased risk? Neurosurg Rev 2022; 45:2385-2399. [PMID: 35243565 DOI: 10.1007/s10143-022-01756-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/06/2022] [Accepted: 02/13/2022] [Indexed: 01/10/2023]
Abstract
Management of lumbar spinal stenosis (LSS) represents the first cause of spinal surgery for the elderly and will increase with the aging population. Although the surgery improves quality of life, the procedure involves anaesthetic and operative risks. The aim of this study was to assess whether the postoperative complication rate was higher for elderly patients and to find confounding factors. We conducted a retrospective study including all LSS surgeries between 2012 and 2020 at the University Hospital of Caen. We compared two populations opposing patients aged over 80 with others. The primary endpoint was the occurrence of a severe complication (SC). Minor complications were the secondary endpoint. Comorbidities, history of lumbar spine surgery and surgical characteristics were recorded. Nine hundred ninety-six patients undergoing surgery for degenerative LSS were identified. Patients over 80 were significantly affected by additional comorbidities: hypertension, heart diseases, higher age-adjusted comorbidity Charlson score, ASA score and use of anticoagulants. Knee-chest position was preferred for younger patients. Older patients underwent a more extensive decompression and had more incidental durotomies. Of the patients, 5.2% presented SC. Age over 80 did not appear to be a significant risk factor for SC, but minor complications increased. Multivariate analysis showed that heart diseases, history of laminectomy, AA-CCI and accidental durotomies were independent risk factors for SC. Surgical management for lumbar spinal stenosis is not associated to a higher rate of severe complications for patients over 80 years of age. However, preoperative risk factors should be investigated to warn the elderly patients that the complication risk is increased although an optimal preparation is the way to avoid them.
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Affiliation(s)
- Frédérick Rault
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France.
| | - Anaïs R Briant
- Unité de Biostatistique Et Recherche Clinique (UBRC), Avenue de la Côte de Nacre, 14000, Caen, France
| | - Hervé Kamga
- Department of Anesthesiology and Critical Care Medicine, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Avenue de La Côte de Nacre, 14000, Caen, France
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Yang Q, Wang J, Chen Y, Lian Q, Shi Z, Zhang Y. Incidence and risk factors of postoperative delirium following total knee arthroplasty: A retrospective Nationwide Inpatient Sample database study. Knee 2022; 35:61-70. [PMID: 35220134 DOI: 10.1016/j.knee.2022.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/21/2021] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postoperative delirium is a common complication following major surgeries, causing a variety of adverse effects. However, the incidence and risk factors of delirium after primary total knee arthroplasty (TKA) has not been well studied using a large-scale national database. METHODS A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005-2014. Patients who underwent primary TKA were included. Patient demographics, comorbidities, length of stay (LOS), total charges, type of payer, in-hospital mortality, and perioperative complications were evaluated. RESULTS A total of 1,228,879 TKAs were obtained from the NIS database. The general incidence of delirium after TKA was 1.00%, which peaked in the year 2008.Patients with delirium after TKA presented increased comorbidities, LOS, hospital charges, usage of medicare, and in-hospital mortality (P < 0.0001). Delirium following TKA was associated with medical complications during hospitalization including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, and urinary tract infection. Risk factors of postoperative delirium included advanced age, neurological disorders, alcohol and drug abuse, depression, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency and chronic blood loss anemia, coagulopathy, congestive heart failure, chronic pulmonary disease, pulmonary circulation disorders, peripheral vascular disorders, chronic renal failure, and teaching hospital. Notably, neurological disorders were found to have the strongest association with the occurrence of postoperative delirium. CONCLUSION A relatively low incidence of delirium after TKA was identified. It is of benefit to study risk factors of postoperative delirium to ensure the appropriate management and moderate its consequences.
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Affiliation(s)
- Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yuhang Chen
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Qiang Lian
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Zhanjun Shi
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
| | - Yang Zhang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
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The Relationship between Perioperative Blood Transfusion and Postoperative Delirium in Patients Undergoing Spinal Fusion Surgery: Clinical Data Warehouse Analysis. Medicina (B Aires) 2022; 58:medicina58020268. [PMID: 35208591 PMCID: PMC8877007 DOI: 10.3390/medicina58020268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/24/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: For preventing postoperative delirium (POD), identifying the risk factors is important. However, the relationship between blood transfusion and POD is still controversial. The aim of this study was to identify the risk factors of POD, to evaluate the impact of blood transfusion in developing POD among people undergoing spinal fusion surgery, and to show the effectiveness of big data analytics using a clinical data warehouse (CDW). Materials and Methods: The medical data of patients who underwent spinal fusion surgery were obtained from the CDW of the five hospitals of Hallym University Medical Center. Clinical features, laboratory findings, perioperative variables, and medication history were compared between patients without POD and with POD. Results: 234 of 3967 patients (5.9%) developed POD. In multivariate logistic regression analysis, the risk factors of POD were as follows: Parkinson’s disease (OR 5.54, 95% CI 2.15–14.27; p < 0.001), intensive care unit (OR 3.45 95% CI 2.42–4.91; p < 0.001), anti-psychotics drug (OR 3.35 95% CI 1.91–5.89; p < 0.001), old age (≥70 years) (OR 3.08, 95% CI 2.14–4.43; p < 0.001), depression (OR 2.8 95% CI 1.27–6.2; p < 0.001). The intraoperative transfusion (OR 1.1, 95% CI 0.91–1.34; p = 0.582), and the postoperative transfusion (OR 0.91, 95% CI 0.74–1.12; p = 0.379) had no statistically significant effect on the incidence of POD. Conclusions: There was no relationship between perioperative blood transfusion and the incidence of POD in spinal fusion surgery. Big data analytics using a CDW could be helpful for the comprehensive understanding of the risk factors of POD, and for preventing POD in spinal fusion surgery.
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Yang Q, Li J, Shi D, Xie H, Wang J, Shi Z, Zhang Y. Incidence and risk factors associated with hospital-acquired pressure ulcers following total hip arthroplasty: A retrospective nationwide inpatient sample database study. J Tissue Viability 2022; 31:332-338. [DOI: 10.1016/j.jtv.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 12/25/2022]
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Jarvers JS, Lange M, Schiemann S, Pfränger J, Heyde CE, Osterhoff G. Risk factors for wound-related complications after surgical stabilization of spinal metastases with a special focus on the effect of postoperative radiation therapy. BMC Surg 2021; 21:423. [PMID: 34920720 PMCID: PMC8684154 DOI: 10.1186/s12893-021-01431-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advancements in the field of oncological therapies during the last decades have led to a significantly prolonged survival of cancer patients. This has led to an increase in the incidence of spinal metastases. The purpose of this study was to assess risk factors for wound-related complications after surgical stabilization of spinal metastases with a special focus on the effect of postoperative RT and its timing. METHODS Patients who had been treated for metastatic spine disease by surgical stabilization followed by radiotherapy between 01/2012 and 03/2019 were included and a retrospective chart review was performed. RESULTS Of 604 patients who underwent stabilizing surgery for spinal metastases, 237 patients (mean age 66 years, SD 11) with a mean follow-up of 11 months (SD 7) were eligible for further analysis. Forty-one patients (17.3%) had wound-related complications, 32 of them before and 9 after beginning of the RT. Revision surgery was necessary in 26 patients (11.0%). Body weight (p = 0.021), obesity (p = 0.018), ASA > 2 (p = 0.001), and start of radiation therapy within 21 days after surgery (p = 0.047) were associated with an increased risk for wound complications. Patients with chemotherapy within 3 weeks of surgery (12%) were more likely to have a wound-related surgical revision (p = 0.031). CONCLUSION Body weight, obesity and ASA > 2 were associated with an increased risk for wound complications. Patients with chemotherapy within 3 weeks of the surgery were more likely to have a wound-related revision surgery. Patients who had begun radiation therapy within 21 days after surgery were more likely to have a wound complication compared to patients who waited longer.
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Affiliation(s)
- Jan-Sven Jarvers
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Maximilian Lange
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Samuel Schiemann
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Jan Pfränger
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany.
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Factors Affecting Postoperative Length of Stay in Patients Undergoing Anterior Lumbar Interbody Fusion. World Neurosurg 2021; 155:e538-e547. [PMID: 34464773 DOI: 10.1016/j.wneu.2021.08.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND With hospital leaders and policy makers increasingly seeking ways to improve resource use, there has been heightened interest in reducing hospital length of stay (LOS) and performing spine procedures on an outpatient basis. We aimed to determine which risk factors correlated with prolonged LOS after anterior lumbar interbody fusion (ALIF). METHODS Medical records for patients who underwent ALIF were retrospectively reviewed. Patients were divided into those who had extended (≥3 days) versus nonextended (<3 days) LOS, and patient demographics, medical comorbidities, and preoperative medications were analyzed. Univariate and multivariate regression were then used to determine preoperative risk factors for extended LOS. RESULTS A total of 166 patients were included (mean age, 48.7 years). Medical comorbidities included hypertension (31.9%), diabetes (8.4%), and obesity (body mass index >30 kg/m2) (48.8%). LOS was not extended in 121 patients and extended in 45. Mean LOS was 2.2 days (95% confidence interval, 1.9-2.5). On multivariate logistic analysis, age ≥65 years (P = 0.001), preoperative benzodiazepine use (P = 0.014), 12-item Short Form mental component score (P = 0.008), estimated blood loss (P = 0.015), time to mobilization (P < 0.001), and total operative time (P = 0.020) were independent predictors for extended LOS. CONCLUSIONS As attempts are made to perform more spine procedure in ambulatory surgical centers, strict patient selection criteria are all critical in making this possible. Our results suggest that age, preoperative benzodiazepine use, higher intraoperative blood loss, delayed mobilization, and lower 12-item Short Form mental component score were correlated with increased LOS. Therefore, inpatient ALIF may be more suitable for patients with these risk factors.
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Kose G, Şirin K, Inel MB, Mertoglu S, Aksakal R, Kurucu Ş. Prevalence and Factors Affecting Postoperative Delirium in a Neurosurgical Intensive Care Unit. J Neurosci Nurs 2021; 53:177-182. [PMID: 34116558 DOI: 10.1097/jnn.0000000000000595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT PURPOSE: The aim of this study was to identify the prevalence of, and factors affecting, postoperative delirium (POD) in patients in the neurosurgical intensive care unit. METHODS: A cross-sectional study of 127 Turkish neurosurgical intensive care unit patients admitted between May 2018 and May 2019 was conducted. Patients were assessed for the development of POD using the Intensive Care Delirium Screening Checklist. We collected other independent data variables daily. Data were analyzed using independent sample t test, χ2 test, and logistic regression. RESULTS: The prevalence rates of POD on the first and second postoperative days were 18.9% and 8.7%, respectively. Logistic regression analysis showed that the Glasgow Coma Scale score, albumin level, Spo2 level, hemoglobin values, undergoing cranial surgery, and having intra-arterial catheter were the independent risk factors for POD. CONCLUSION: These findings may contribute to identifying patients at risk for developing POD and developing strategies to improve patient outcomes.
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Yang QF, Lin ZM, Yang S, Wang PK, Chen R, Wang J. Incidence and Risk Factors of In-Hospital Prosthesis-Related Complications Following Total Knee Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study. Orthop Surg 2021; 13:1579-1586. [PMID: 34109750 PMCID: PMC8313154 DOI: 10.1111/os.13008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/13/2021] [Accepted: 03/11/2021] [Indexed: 01/28/2023] Open
Abstract
Objective To examine the incidence and risk factors of in‐hospital prosthesis‐related complications (PRCs) following total knee arthroplasty (TKA) using a large‐scale national database. Methods A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005–2014. Patients who underwent TKA were included. The recruited cases were divided into two groups according to the occurrence of PRCs. Patient demographics (age, sex, and race), hospital characteristics (type of admission and payer, and bedsize, teaching status, location, and region of hospital), length of stay (LOS), total charges during hospitalization, in‐hospital mortality, comorbidities, and perioperative complications were analyzed. Results A total of 1,227,244 TKAs were captured from the NIS database. There were 8484 cases of in‐hospital PRCs after TKA and the overall incidence was 0.69%, with a slight downward trend annually. Periprosthetic joint infection (PJI) was the main category among PRCs (0.20%), followed by mechanical loosening (0.04%), dislocation (0.02%), and periprosthetic fracture (PPF) (0.01%). Patients suffered from in‐hospital PRCs were 3 years younger (64 years vs 67 years) and 6.51% more likely to be male (43.60% vs 37.09%) compared to the nonaffected population (P < 0.0001). Additionally, patients experiencing in‐hospital PRCs after TKA were 2.11% less likely through elective admission (92.07% vs 94.18%) while 2.34% more likely in teaching hospital (45.53% vs 43.19%) than those without these complications (P < 0.0001). Furthermore, the occurrence of in‐hospital PRCs was associated with longer LOS (4 days vs 3 days; P < 0.0001), more total charges ($53,418 vs $41,204, P < 0.0001), and higher in‐hospital mortality (0.30% vs 0.07%; P < 0.0001). Multivariate logistic regression was performed to identify independent risk factors of in‐hospital PRCs after TKA which included younger age, male, non‐elective admission, teaching hospital, deficiency and chronic blood loss anemia, coagulopathy, congestive heart failure, depression, diabetes with chronic complications, fluid and electrolyte disorders, pulmonary circulation disorders, metastatic cancer, and weight loss. Besides, in‐hospital PRCs after TKA were associated with secondary osteoarthritis, inflammatory arthritis, prior knee arthroscopy, acute renal failure, acute myocardial infarction, deep vein thrombosis, sepsis, transfusion, and wound dehiscence. Conclusion It is beneficial to study the risk factors of in‐hospital PRCs after TKA to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.
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Affiliation(s)
- Qin-Feng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ze-Ming Lin
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sheng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pin-Kai Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rong Chen
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
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