Clinical value of combined use of FRAIL scale and hematological parameters in predicting postoperative delirium in elderly patients after spinal surgery

English Keywords:FRAIL scale  Elderly  Spinal surgery  Postoperative delirium  Frailty

English Abstract:

  【Abstract】 Objectives: To investigate the clinical value of the FRAIL scale combined with multiple hematological indicators in predicting postoperative delirium(POD) in elderly patients undergoing spinal surgery. Methods: The clinical data of 398 elderly patients who underwent spinal surgery at the Department of Orthopedics, the First Affiliated Hospital of Harbin Medical University were retrospectively analyzed. Among them, 218 were male and 180 were female; with an age range of 63 to 87(72.8±6.3) years; 137 underwent cervical spine surgery, 40 underwent thoracic spine surgery, and 221 underwent lumbar spine surgery; 21 surgeries were classified as Level 1, 60 as Level 2, 238 as Level 3, and 79 as Level 4. Based on the Diagnostic and Statistical Manual of Mental Disorders criteria, the patients were assessed to be with or without delirium on postoperative 7d, and were divided into a POD group and a non-POD group. The clinical data of the patients were extracted, including preoperative frailty(FRAIL scale score≥3 points) and hematological indicators such as platelets, blood glucose, hemoglobin, procalcitonin, interleukin-17, albumin, blood uric acid, C-reactive protein, 25-hydroxy vitamin D[25(OH)D], neutrophil-to-lymphocyte ratio(NLR), and C-reactive protein/albumin ratio(CAR). Multivariate logistic regression was performed to analyze risk factors for POD, while ROC curves were used to evaluate the predictive value of combined frailty, CAR and 25(OH)D. Results: There were 122 cases in the POD group and 276 cases in the non-POD group. Before operation, 93 patients were frail(FRAIL scale≥3 points), and 305 patients were not frail(FRAIL scale<3 points). Compared with the non-POD group, the POD group exhibited significantly older age, higher preoperative frailty rates, serum procalcitonin, uric acid, and CAR levels, longer operative time, and lower serum 25(OH)D levels(P<0.05). Multivariate logistic regression analysis identified preoperative frailty(OR=1.645, 95%CI: 1.280-2.116) and CAR(OR=1.508, 95%CI: 1.201-1.894) were independent risk factors for POD in elderly patients undergoing spinal surgery, while 25(OH)D was a protective factor(OR=0.694, 95%CI: 0.541-0.891). The AUC for predicting POD using frailty, CAR, or 25(OH)D alone ranged from 0.687 to 0.790, whereas the combined AUC for all three factors was 0.868(95%CI: 0.832-0.904), with sensitivity of 79.51% and specificity of 80.07%. Conclusions: Frailty, CAR, and 25(OH)D are independent risk factors for POD in elderly patients undergoing spinal surgery, and the combination of the three has a good predictive ability for POD.