Analysis of risk factors for delirium after cervical spinal operation in elderly patients

English Keywords:Elderly  Cervical spine surgery  Delirium  Risk factors

English Abstract:

  【Abstract】 Objectives: To explore the risk factors of postoperative delirium in elderly patients after cervical spine operation. Methods: The clinical data of 252 elderly patients treated with cervical spine surgery in our hospital from January 2019 to October 2022, including 148 males and 104 females, with a mean age of 68.9±6.1 years(60-91 years) old were retrospectively analyzed. The Confusion Assessment Method (CAM) was utilized to assess whether the patients exhibited delirium after surgery in a week, and they were divided into delirium group and non-delirium group. Data were collected, such as age, sex, disease type, smoking history, drinking history, comorbidities, body mass index(BMI), bone mineral density(BMD), sleep disorders, the Saint Louis University Mental Status(SLUMS) score, surgical approach, American Society of Anesthesiologists(ASA) grade, preoperative hematocrit and electrolytes concentration, preoperative and postoperative 1d hemoglobin and albumin levels, operative time, anesthesia time, blood loss, postoperative hospitalization in ICU, the occurrence of postoperative hypoxaemia and postoperative hypotension within 3 days; Narcotics-related drug use included: anticholinergics, benzodiazepines, dexmedetomidine; Before operation and at 3d after operation, visual analogue scale(VAS) was used to evaluate the pain status, and Japanese Orthopaedic Association(JOA) score and neck disability index(NDI) were adopted to assess the cervical function. The differences between the two groups were analyzed with independent sample t-test or χ2 test, and indexes with intergroup difference were analyzed with the binary logistic regression method to determine the risk factors for delirum after operation. Results: There were 31 patients with postoperative delirium and 221 patients without delirium. Univariate analysis showed that age, stroke history, Parkinson′s disease, pulmonary disease, sleep disorder, SLUMS score, preoperative albumin level, operative time, anesthesia time, blood loss, postoperative albumin level, postoperative hospitalization in ICU and postoperative hypoxemia were with statistically significant differences between delirium group and non-delirium group(P<0.05); Sex, disease type, smoking history, drinking history, hypertension, diabetes, BMI, BMD, surgical approach, ASA grade, preoperative and postoperative VAS scores, JOA scores, NDI, and hemoglobin levels, preoperative hematocrit, electrolyte concentration, and the use of anticholinergics, benzodiazepines, and dexmedetomidine were not statistically different between the two groups(P>0.05). The multivariate logistic regression analysis showed age≥70 years(OR=2.844, P=0.031), stroke history(OR=3.476, P=0.012), Parkinson′s disease(OR=18.815, P=0.003), pulmonary disease(OR=7.213, P=0.000), sleep disorders(OR=3.010, P=0.025), SLUMS score≤21(OR=4.529, P=0.012), and postoperative hospitalization in ICU(OR=4.131, P=0.005) were the risk factors for delirium after cervical spinal operation. Conclusions: Elderly patients who age≥70 years, have stroke history, Parkinson′s disease, pulmonary disease, sleep disorders, SLUMS score≤21, and are hospitalized in ICU after operation are prone to delirium after operation in cervical spine.