围手术期全程血液管理在老年腰椎退行性疾病治疗中的应用

目的观察围手术期全程血液管理对老年腰椎退行性疾病患者术中出血量、术后引流量以及输血量的影响,探讨减少围手术期出血的有效方法。方法回顾性分析2014年1月—2016年12月收治的90例老年退行性腰椎疾病患者,早期45例患者采用围手术期常规血液管理模式(常规组),后期45例患者采用围手术期全程血管理模式(全程组)。记录并比较2组患者手术时间、术中出血量、术后引流量、输血例数及输血量、血红蛋白浓度和红细胞压积。结果全程组手术时间、术中出血量、术后引流量、输血例数、输血量均低于常规组,术后3 d及1周血红蛋白浓度、红细胞压积均高于常规组,差异均具有统计学意义(P0.05)。结论老年腰椎退行性疾病患者采用围手术期全程血液管理可有效降低术中出血量和术后引流量,降低输血量和输血率,有利于患者术后恢复。     

老年脊柱手术患者术后发生谵妄的危险因素分析

[目的]探讨老年脊柱手术患者术后发生谵妄的危险因素。[方法]回顾分析2014年8月～2016年10月在本院行脊柱内固定手术的老年患者(年龄65岁)共846例的临床资料,其中,术后出现谵妄者92例,男58例,女44例,其中颈椎手术38例,腰椎手术54例,而其余745例患者术后无谵妄。比较两组间性别、年龄、体重指数、吸烟史,术前主要内科合并症、手术部位、手术时间、术中失血量、术后是否发生低氧血症以及术后是否使用止痛泵等,寻找谵妄相关危险因素。并应用Logistic回归进行多因素分析。[结果]单因素分析结果显示年龄、术前血红蛋白值、糖尿病史、脑卒中病史、手术时间及术后低氧血症在谵妄组和非谵妄组之间的差异有统计学意义(P0.05)。多因素logistic回归分析表明术前血红蛋白低(OR=2.026,95%CI 1.229～3.338,P=0.006),高血压病史(OR=1.633,95%CI 1.008～2.646,P=0.046)、慢阻肺疾病史(OR=2.222,95%CI 1.147～4.302,P=0.018)、颈椎手术(OR=1.544,95%CI 1.298～1.994,P=0.048)、手术时间长(OR=1.010,95%CI 1.004～1.016,P=0.002)是术后发生谵妄的独立危险因素。[结论]术前血红蛋白低、高血压病史、慢阻肺疾病史、颈椎手术、手术时间长是术后发生谵妄的独立危险因素。     

自体血回输在腰椎滑脱症手术中应用的前瞻性研究

[目的]比较腰椎滑脱症患者术中应用与不应用自体血回输后总失血量、血红蛋白(Hb)、红细胞压积(HCT)变化以及异体输血情况。[方法]本研究为前瞻性随机对照试验,40例腰椎滑脱手术治疗患者随机分为自体血回输组(A组),不自体血回输组(B组)。自体血回输组自手术开始同步收集术中出血,清洗过滤后术中或术后2 h内完全回输。将两组患者术前与术后(第1、3、5、7 d)的Hb、HCT、总失血量、异体血使用量及使用率进行对比分析。[结果]两组患者的年龄、体重、性别比无统计学差异。A组回输自体血的容量平均为(319.22±161.57)ml。两组术前的Hb(P=0.480)及HCT(P=0.271)值均无统计学差异(P>0.05),但术后A组上述两指标值均>B组(P>0.05)。术后两组Hb及HCT均逐渐下降,术后第3 d最低,术后第5、7 d均呈增长趋势。术前分别与术后1、3、5、7 d的血红蛋白及红细胞压积的差值相比较,A组均相似文献   

老年患者脊柱手术术后谵妄危险因素分析的回顾性研究

目的:探讨老年患者脊柱手术术后谵妄的发生率及相关危险因素。方法:采用回顾性分析2016年1月至2018年11月收治的老年脊柱手术病例436例,根据术后是否发生谵妄分为谵妄组和非谵妄组。记录患者的性别、年龄、身体质量指数,糖尿病史,冠心病史,慢性阻塞性肺疾病史,术前白细胞计数,术前红细胞比容,术前血红蛋白水平,手术方式,手术时间,麻醉时间,美国麻醉医师协会(ASA)评分,心功能分级,术中失血量,术中输血量,术中芬太尼、异丙酚和地佐辛的用量,术后白细胞计数,术后红细胞比容,术后血红蛋白水平,术后电解质(钠离子、钾离子),采用单因素Logistic回归分析有统计学意义的危险因素后进行多元Logistic回归分析进一步探讨独立危险因素。结果:纳入436例中112例老年患者术后出现谵妄,发生率25.68%。谵妄组与非谵妄组在年龄、术前白细胞计数、术前红细胞比容、术后红细胞比容、术后血红蛋白水平、术后钠离子浓度、麻醉时间、ASA评分、心功能评分、术中失血量、术后地佐辛使用量、糖尿病史、冠心病史、慢性阻塞性肺疾病史方面差异有统计学意义(P0.05),通过多因素Logistic回归分析显示年龄、ASA评分、术后地佐辛量、慢性阻塞性肺疾病史是老年患者脊柱手术术后谵妄发生的独立危险因素。结论:患者高龄72岁、ASA评分2分、地佐辛镇痛药物的使用以及患者合并慢性阻塞性肺疾病史是术后谵妄发生的独立危险因素。     

加速康复模式下初次全髋关节置换术后引流与不引流比较

[目的]评价加速康复模式下初次全髋关节置换术(total hip arthroplasty, THA)后,不放置引流管的安全性和有效性。[方法]选择本科室2018年1月～2018年10月加速康复外科模式下初次THA患者120例,随机分为引流组和无引流组,每组各60例。引流管术后24 h拔除。比较两组患者术前和术后血红蛋白、红细胞压积差值、输血率、术后VAS评分、并发症等指标的差异。[结果]两组患者在性别、年龄、体重、身高、手术侧别等基线资料上差异无统计学意义。引流组引流量为(205.28±113.35) ml,两组血红蛋白和红细胞压积术前术后、输血率等指标比较,差异无统计学意义(P0.05)。两组术后24、48、72 h VAS评分比较,差异无统计学意义(P0.05)。两组术后并发症差异无统计学意义(P0.05)。[结论]本研究提示在加速康复模式下,初次THA术后放置引流管并不优于不放置引流管。     

神经外科重症患者术后谵妄的危险因素分析

目的 分析和探讨神经外科重症患者发生术后谵妄的危险因素。方法 本研究采用连续入组方便取样的方法,纳入符合入选标准的患者。统计术中出血量与手术时间、术后血红蛋白、白蛋白、淋巴细胞相对值、中性粒细胞相对值、红细胞压积、体温、机械通气时间、格拉斯哥昏迷评分（GCS）和二氧化碳结合力等,应用意识模糊评估法（CAM-ICU）对患者进行评估,采用多因素Logistic回归分析术后谵妄的危险因素。结果 本研究共纳入130例患者,其中谵妄患者58例（谵妄组）,余72例患者纳入非谵妄组。单因素分析显示：谵妄组患者的术后血红蛋白、白蛋白、红细胞压积、GCS评分和二氧化碳结合力明显低于非谵妄组,术后淋巴细胞相对值、中性粒细胞相对值、体温明显高于非谵妄组,机械通气时间明显长于非谵妄组（P<0.05）。Logistic多元回归分析显示：体温（OR=2.261,95％CI 1.094~4.673,P=0.028）、机械通气时间（OR=1.006,95％CI 1.002~1.009,P=0.001）、GCS评分（OR=1.436,95％CI 1.211~1.703,P＜0.001）和二氧化碳结合力（OR=1.176,95％CI 1.086~1.274,P＜0.001）是神经外科重症患者谵妄的独立危险因素。结论 随着体温升高、机械通气时间延长、GCS评分降低和二氧化碳结合力降低,神经外科重症患者谵妄的发生率增高。     

双侧全髋关节置换术中自体血回输作用探讨

目的 双侧全髋关节置换术病人经常需要输入大量术中及术后异体血,其危险性包括溶血反应、感染乙肝或丙肝、感染HIV或梅毒等.减少异体血输入的最常用方法是采用术中自体血回输.该回顾性研究旨在评价术中自体血回输能否具有减少双侧全髋关节置换术围手术期异体输血总量的作用.方法 自2003年1月至2007年6月期间,行双侧首次全髋关节置换术51例,其中26例采用术中自体血回输(A组),25例未用术中自体血回输(B组),回顾性比较两组病人的性别、年龄、体重、身高、疾病、手术医生、手术时间,术前血红蛋白及红细胞压积,术中出血量、自体血回输量、异体血使用量,术后引流量、异体血使用量,术后1、3、7天血红蛋白和红细胞压积.结果 A组术中自体血回输330.7±122.7ml (100～557ml).术中异体血输入量在A组为661.5±437.3ml,B组为888.0±483.3ml(P=0.085).术后异体血输入量在A组为607.7±672.9ml,B组为328.0±423.8ml(P=0.082).两组之间术中和术后异体血总输入量无统计学差异(A组1269.2±807.8ml,B组1216.0±706.9ml,P=0.804).两组之间术后第1天血红蛋白和红细胞压积无统计学差异,而术后第3天血红蛋白和红细胞压积有统计学差异(P=0.020和P=0.013),术后第7天血红蛋白和红细胞压积又无统计学差异.结论 双侧全髋关节置换术术中自体血回输能够减少术中异体输血量,但不能减少围手术期异体输血总量.     

老年患者颈椎手术后发生谵妄的危险因素分析

【摘要】 目的：探讨老年患者颈椎手术后发生谵妄的危险因素。方法：回顾性分析2019年1月~2022年10月于我院骨科行颈椎手术治疗的252例老年患者的临床资料,其中男148例,女104例,平均年龄68.9±6.1岁（60~91岁）。根据意识模糊评估法（confusion assessment method,CAM）评估患者术后7d内是否发生谵妄,将患者分为谵妄组和非谵妄组。收集患者年龄、性别、疾病类型、吸烟史、饮酒史、合并症、体重指数（body mass index,BMI）、骨密度（bone mineral density,BMD）、睡眠障碍史、圣路易斯大学精神状态（Saint Louis University Mental Status,SLUMS）评分、手术入路、美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级、术前红细胞压积和电解质浓度、术前和术后1d血红蛋白和白蛋白水平、手术时间、麻醉时间、失血量、术后是否进入ICU及术后3d内低氧血症、低血压发生等情况;麻醉相关药物使用情况,包括抗胆碱药物、苯二氮卓类药物、右美托咪定等;术前及术后3d采用视觉模拟评分量表（visual analogue scale,VAS）评估疼痛状态、日本骨科协会（Japanese Orthopaedic Association,JOA）评分和颈椎功能障碍指数（neck disability index,NDI）评价颈椎功能。通过独立样本t检验或χ2检验分析两组间差异,对两组间有差异的指标采用二元Logistic回归方法分析患者术后发生谵妄的危险因素。结果：颈椎手术后发生谵妄者31例,未发生谵妄者221例,术后谵妄发生率12.3%。单因素分析结果显示年龄、脑卒中病史、帕金森病、肺部疾病、睡眠障碍史、SLUMS评分、术前白蛋白水平、手术时间、麻醉时间、失血量、术后白蛋白水平、术后入住ICU、术后低氧血症等13个因素在谵妄组与非谵妄组间差异存在统计学意义（P＜0.05）;性别、疾病类型、吸烟史、饮酒史、高血压、糖尿病、BMI、BMD、手术入路、ASA分级、术前和术后VAS评分、JOA评分、NDI及血红蛋白水平、术前红细胞压积和电解质浓度、抗胆碱药物、苯二氮卓类药物、右美托咪定的使用在两组间无统计学差异（P＞0.05）。多因素Logistic回归分析结果显示年龄≥70岁（OR=2.844,P=0.031）、脑卒中病史（OR=3.476,P=0.012）、帕金森病（OR=18.815,P=0.003）、肺部疾病（OR=7.213,P=0.000）、睡眠障碍史（OR=3.010,P=0.025）、SLUMS评分≤21分（OR=4.529,P=0.012）、术后进入ICU（OR=4.131,P=0.005）是颈椎手术后发生谵妄的危险因素。结论：年龄≥70岁、脑卒中病史、帕金森病、肺部疾病史、睡眠障碍史、SLUMS评分≤21分、术后进入ICU是老年患者颈椎手术后发生谵妄的独立危险因素。     

老年患者全膝和全髋关节置换术围手术期血红蛋白及红细胞压积的转归

 目的 探讨非输血老年患者全膝和全髋关节置换术围手术期血红蛋白及红细胞压积的自然转归及其与性别、手术类型之间的关系。方法 2012年9月至2013年2月接受全膝关节或全髋关节置换术的60岁以上骨关节炎患者107例,男54例,女53例;年龄60~82岁,平均69.4岁。检测术前、手术日、术后第1~7天,3周、6周、3个月、6个月的血红蛋白和红细胞压积,分析其变化趋势。将不同性别和手术类别各个时点的血红蛋白和红细胞压积进行比较,评价性别和手术类别对血红蛋白和红细胞压积转归的影响。结果 所有患者血红蛋白和红细胞压积均于术后至第4天出现明显下降,最低点出现在术后第4天,术后1周至3周,血红蛋白和红细胞压积回升最快,在术后6周至3个月逐渐恢复到术前水平。在下降和恢复过程的各个时点,男性与女性患者的血红蛋白、红细胞压积差异无统计学意义。全髋关节置换组术后第4天内血红蛋白下降多于全膝关节置换组,全髋关节置换组手术日红细胞压积下降多于全膝关节置换组,差异均有统计学意义,其他时点两组血红蛋白和红细胞压积下降值的差异无统计学意义。结论 全膝和全髋关节置换术后血红蛋白和红细胞压积的最低点出现在术后第4天,术后6~12周恢复。性别因素对围手术期失血及恢复无明显影响。全髋关节置换术后血红蛋白和红细胞压积下降多于全膝关节置换。     

麻醉方式的选择对股骨转子间骨折患者围手术期的影响

[目的]评估不同麻醉方式对髋部骨折患者围手术期失血、住院时间和相关费用的影响,为髋部骨折围手术期治疗提供一定的参考。[方法]回顾性分析2012年4月~2014年4月502例连续就诊于本院创伤骨科的股骨转子间骨折患者,其中资料完整409例。按照麻醉方式的不同,分为全麻组(83例)和椎管内麻醉组(326例)。收集信息包括一般资料、手术时间、入院及术后第1 d时血常规检查、围手术期输血量、基础疾病、住院时间、麻醉方式和住院期间并发症。采用Gross方程计算围手术期总失血量和隐性失血量。[结果]409例患者纳入统计分析。椎管内麻醉组术中失血量为(141.7±110.7)ml明显低于全麻组(242.0±235.1)ml(P=0.001)(P0.05)。同时椎管内麻醉组隐性失血量(P=0.001)和总失血量(P=0.001)明显低于全麻组(P0.05)。椎管内麻醉组血红蛋白和红细胞压积变化分别为(23.8±16.5)g/L和(6.9±4.8)%。全麻组血红蛋白和红细胞压积变化分别为(35.1±14.8)g/L和(10.5±4.1)%,明显高于椎管内麻醉组(P=0.001)(P0.05)。椎管内麻醉组输血费用明显低于全麻组(P=0.042)(P0.05),但两组之间麻醉费用(P=0.639)、手术费用(P=0.163)和总费用(P=0.067)无明显差异(P0.05)。两组之间住院期间并发症发生率无显著差异(P0.05)。[结论]同全麻相比,椎管内麻醉可以减少围手术期失血量、输血量和输血相关费用;麻醉方式的选择同住院时间、住院期间并发症和住院费用无关。     

Postoperative delirium in spine surgery.

BACKGROUND CONTEXT: Postoperative delirium is a great concern in the treatment of hip fracture. However, there have been no reports regarding the postoperative delirium in spine surgery. PURPOSE: To determine the incidence and risk factors for postoperative delirium in the patients who have had spine surgery. STUDY DESIGN/SETTING: The incidence and intraoperative risk factors of postoperative delirium were retrospectively examined in patients who had spine surgery during a 3-year period. PATIENT SAMPLE: Three hundred forty-one patients who underwent spine surgery from 2000 to 2002 were included. METHODS: The presence of delirium was determened by the Confusion Assessment Method. Laboratory data were checked preoperatively, at 1 day and 1 week postoperatively. The prognosis of postoperative delirium was evaluated. RESULTS: Postoperative delirium was found in 13 patients; all of them were in their 70's or 80's. The incidence of delirium was 12.5% in the patients over 70 years old. Hemoglobin and hematocrit levels at 1 day after surgery in the delirium group were significantly lower than those in the control group. One patient had persistent cognitive dysfunction after surgery. Two patients who developed postoperative delirium died during the follow-up period. CONCLUSION: Low concentrations of hemoglobin and hematocrit 1 day after surgery were risk factors for postoperative delirium. As delirium is thought to represent not only brain dysfunction, but also impaired general physical condition, careful observation is necessary for the management of patients with postoperative delirium.     

骨科常见手术术后谵妄的危险因素分析

 目的 分析骨科常见手术术后发生谵妄的相关危险因素。方法 回顾性分析2011年1月至2013年12月行股骨转子间骨折内固定术（155例）、人工股骨头置换术（64例）、全髋关节置换术（169例）、膝关节置换术（65例）和肩关节周围手术（72例）患者525例,根据是否发生术后谵妄分为谵妄组（56例）和非谵妄组（469例）。记录谵妄组和非谵妄组患者年龄、性别、血型以及住院天数、手术方式、麻醉方式、术前准备时间、术前基础疾病状况、术前及术后白蛋白、术前及术后血红蛋白水平、术后电解质是否紊乱、术中出血量、手术持续时间、术后是否ICU监护和输血量等围手术期因素共17项。采用单因素和多因素Logistic回归分析术后发生谵妄的相关危险因素。结果 单因素Logistic回归分析结果显示,可能与术后谵妄相关的因素有年龄、手术方式、术前准备时间、术前白蛋白水平、术前血红蛋白水平、术后电解质是否紊乱、手术持续时间、是否术后ICU监护和输血量等9项。多因素Logistic回归分析显示：年龄70~80岁和>80岁组术后谵妄发生率高于年龄<70岁组,OR值分别为12.998（95%CI：2.829,59.713）和36.210（95%CI：8.222,159.476）;术前准备时间4~6 d组术后谵妄发生率高于术前准备时间≥7 d组,OR值为3.903（95%CI：1.658,9.188）;术后电解质紊乱组术后谵妄的发生率高于电解质正常组,OR值为2.160（95%CI：1.065,4.382）。结论 高龄、术前准备时间不充分和术后电解质紊乱是骨科术后发生谵妄的高危因素。     

Probable risk factors for postoperative delirium in patients undergoing spinal surgery

Postoperative delirium and its risk factors had been widely reported in several kinds of surgeries; however, there is only one known article relative to postoperative delirium in spinal surgery. We retrospectively examined the incidence of postoperative delirium and the probable risk factors in patients undergoing spinal surgery in our hospital, with the same aged non-delirium patients as controls, over a 6-month period. Studies about postoperative delirium were reviewed and referenced for variable factors collecting in our study. T tests, χ ² test and logistic regression analysis were performed to evaluate the various factors related to postoperative delirium. A total of 18 patients (3.3%), all of them were aged 54 years or older, had postoperative delirium after surgery. Patients without postoperative delirium aged 54 years or older served as the control group. The percentage of patients older than 65 years (P = 0.003), with comorbid diseases such as diabetes mellitus (P = 0.042) or central nervous system disorders (P = 0.013), with a surgical history (P = 0.028) in delirium group was larger than the control group. The absolute number of medications being taken before the operation in the delirium patients was also more than the control group (P = 0.000). The percentage of patients transfused with 800 mL or more blood was also larger (P = 0.024) in delirium group was larger than the control group. Logistic regression analysis showed that central nervous system disorder (OR 6.480), surgical history (OR 3.499), age older than 65 years (OR 3.390), diabetes mellitus (OR 2.981), transfused 800 mL or more blood (OR 2.537), and hemoglobin less than 100 g/L (OR 0.281) were significantly related to the occurrence postoperative delirium. Our findings suggest that postoperative delirium in spinal surgery can also occurred in younger patients and with an acceptable incidence in total. The risk for postoperative delirium is multifactorial. More prospective research is necessary in order to evaluate these and other risk factors in greater detail.     

Endovascular versus open approach to aortic aneurysm repair surgery: rates of postoperative delirium

Purpose

Our objective was to compare open and endovascular aortic aneurysm repair with respect to postoperative delirium.

Methods

After Institutional Ethics Review Board approval, we conducted a retrospective review of all patients who underwent abdominal and thoraco-abdominal aortic aneurysm repair surgery at Toronto General Hospital during June 2006 to December 2007. Patients were classed into either the OPEN or the endovascular (EVAR) group based on the type of surgery and were assessed for the presence of delirium after surgery. The NEECHAM Confusion Scale and the validated chart review instrument were used for diagnosis of delirium. Patients with dementia and/or abnormal levels of consciousness preoperatively were excluded.

Results

There were 256 patients included in the study, 149 (58%) in the OPEN group and 107 (42%) in the EVAR group. Patients in the EVAR group were considerably older, 74 (10) yr vs 68 (9) yr, and they had shorter duration of surgery, 150 [119, 180] min vs 200 [165, 260] min, respectively, P?<?0.0001. Postoperative delirium was present in 43 (29%) patients in the OPEN group and 14 (13%) patients in the EVAR group (95% confidence interval [CI], 22 to 36 vs 95% CI, 7 to 19, respectively; P?=?0.003). Hospital length of stay was 8.3 [6.6, 13.4] days in the OPEN group and 4.5 [3.1, 6.4] days in the EVAR group, P?<?0.0001.

Conclusions

Perioperative management of patients undergoing endovascular aortic aneurysm repair was associated with lower rates of delirium after surgery than that of patients undergoing open aortic aneurysm repair.     

Incidence and Risk Factors of Postoperative Delirium in Patients with Esophageal Cancer

Background

Postoperative delirium is a common complication after major surgery and is characterized by acute confusion with fluctuating consciousness. The aim of this study was to investigate the incidence and risk factors of postoperative delirium in patients with esophageal cancer.

Methods

We conducted a retrospective cohort analysis of 306 consecutive patients who had undergone an esophagectomy at Keio University Hospital from January 1998 to December 2009. All data were assessed by psychiatrists, and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual Disorder, fourth edition. Univariate and multivariate analyses were performed.

Results

Postoperative delirium developed in 153 (50.0?%) of 306 patients. One hundred fourteen (37.3?%) of the 306 patients required psychoactive medication for symptoms associated with delirium. Univariate analyses showed that older age, male gender, additional flunitrazepam for sedation in intensive care unit (ICU) after surgery, longer periods of time under mechanical ventilation after surgery, longer ICU stays, occurrence of postoperative complications, and longer hospital stays were significantly associated with postoperative delirium. Multivariate analysis revealed that development of delirium was linked to older age, additional flunitrazepam in ICU, and occurrence of postoperative complication.

Conclusions

The development of postoperative delirium in patients with esophageal cancer is a problem that cannot be ignored. Our results suggest that the risk of developing delirium is associated with older age, use of flunitrazepam in ICU, and postoperative complications.     

腰椎后路融合术后急性手术部位感染的危险因素分析

目的探讨腰椎后路融合术后发生急性手术部位感染的相关危险因素。方法回顾性分析2016年1月至2018年12月于我院脊柱外科行腰椎后路融合手术的330例病人的临床资料。病人主要诊断包括腰椎椎管狭窄、腰椎间盘突出症、腰椎骨折、肿瘤等。根据术后是否发生急性手术部位感染将病人分为感染组和非感染组,选择年龄、性别、身体质量指数(body mass index, BMI)、吸烟、高血压、糖尿病、骨质疏松症、手术节段数、手术时间、出血量、切口长度、术后引流时间、尿路感染和脑脊液漏等可能影响术后急性手术部位感染的因素,先后应用单因素分析和二元Logistic回归分析腰椎后路融合术后急性手术部位感染的危险因素。结果共有19例术后发生了急性手术部位感染,发生率为5.76%(19/330)。单因素分析结果显示:两组病人的年龄、BMI、糖尿病、骨质疏松、手术节段、手术时间、出血量、脑脊液漏、尿路感染以及切口长度的差异均有统计学意义(P均<0.05)。二元Logistic回归分析结果显示:BMI[OR=1.429,95%CI(1.059,1.929),P=0.020]、合并糖尿病[OR=9.568,95%CI(2.183,41.935),P=0.003]、手术时间[OR=8.868,95%CI(1.992,39.482),P=0.004]、切口长度[OR=7.257,95%CI(2.937,16.719),P<0.001]为腰椎后路融合术后急性手术部位感染的独立危险因素。结论为了降低腰椎术后急性手术部位感染的发生率,围术期应合理评估控制相关危险因素,以获得更好的治疗效果和病人满意度。     

Hospital administrative database underestimates delirium rate after cardiac surgery

Purpose

Administrative electronic databases are highly specific for postoperative complications, but they lack sensitivity. The objective of this study was to determine the incidence of delirium after cardiac surgery using a targeted prospectively collected dataset and to compare the findings with the incidence of delirium in the same cohort of patients identified in a hospital administrative database.

Methods

Following Research Ethics Board approval, we compared delirium rates in a prospectively collected data research database with delirium rates in the same cohort of patients in an administrative hospital database where delirium was identified from codes entered by coding and abstracting staff. Every 12 hr postoperatively, delirium was assessed with a Confusion Assessment Method in the Intensive Care Unit. The administrative database contained the International Classification of Diseases version 10 (ICD-10) codes for patient diagnoses. The ICD-10 codes were extracted from the administrative database for each patient in the research database and were checked for the presence of the ICD-10 code for delirium.

Results

Data from a cohort of 1,528 patients were analyzed. Postoperative delirium was identified in 182 (11.9%) patients (95% confidence interval [CI], 10.3-13.5%) in the research dataset and 46 (3%) patients (95% CI, 2.2-3.8%) in the administrative dataset (P < 0.001). Thirteen (0.85%) patients who were coded for delirium in the administrative database were not identified in the research dataset. The median onset of postoperative delirium in these patients was significantly delayed (4 [3-9] days) compared with patients identified by both datasets (2 [1-9] days) and compared with patients from the research database only (1 [1-14] days) (P = 0.007).

Conclusion

Postoperative delirium rates after cardiac surgery are underestimated by the hospital administrative database.