The association between preoperative lacunar infarcts and postoperative delirium in elderly patients undergoing major abdominal surgery: a prospective cohort study

IF 3.4 3区医学 Q2 GERIATRICS & GERONTOLOGY

Aging Clinical and Experimental Research Pub Date : 2025-01-29 DOI:10.1007/s40520-024-02909-1

Danni Li, Pan Gu, Yuhao Wang, Yuchen Yao, Dan Fan

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引用次数: 0

Abstract

Objective

The primary goal was to investigate whether the presence of preoperative lacunar infarcts (LACI) was associated with postoperative delirium (POD) in elderly patients undergoing elective major abdominal surgery.

Design

A prospective cohort study.

Setting and participants

Patients aged ≥ 65 years from a tertiary level A hospital in China.

Methods

The POD was assessed once daily within the first postoperative 3 days using the Confusion Assessment Method. Neurocognitive tests using the Mini-mental State Examination (MMSE) and the Beijing version of the Montreal Cognitive Assessment scales were carried out within 3 days before surgery and 4–7 days after surgery. Regional cerebral oxygen saturation (rScO₂) was recorded in the operating room. Logistic regression analysis was used to evaluate the impact of preoperative LACI on POD and to explore the risk factors for POD.

Results

A total of 369 participants were analyzed, 161 in the preoperative LACI-positive group (P group), and 208 in the preoperative LACI-negative group (N group), respectively. The incidence of POD was 32.7% in our study. The incidence of POD was significantly higher in the P group than in the N group (39.1 vs 27.9%, risk ratio, 1.66; 95% CI 1.07–2.58; P = 0.022). Furthermore, the P group exhibited lower mean rScO₂ values during the procedure (P < 0.001). In exploratory analysis, the advanced age (P = 0.005), sex (P = 0.038), and lower preoperative MMSE score (P = 0.019) were independent risk factors for POD in patients undergoing major abdominal surgery.

Conclusions and implications

Preoperative LACI was common, and constituted a risk factor for POD in older patients undergoing abdominal surgery. Despite the frequent subclinical nature, the preoperative LACI led to lower mean rScO₂ during the procedure. These findings could help early identification of high-risk POD patients.

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来源期刊

Aging Clinical and Experimental Research 医学-老年医学

CiteScore

7.90

自引率

5.00%

发文量

283

审稿时长

1 months

期刊介绍： Aging clinical and experimental research offers a multidisciplinary forum on the progressing field of gerontology and geriatrics. The areas covered by the journal include: biogerontology, neurosciences, epidemiology, clinical gerontology and geriatric assessment, social, economical and behavioral gerontology. “Aging clinical and experimental research” appears bimonthly and publishes review articles, original papers and case reports.