Patient-reported outcomes as drivers of postoperative delirium in the postanaesthesia care unit: Data from a one-year prospective cohort study.

IF 6.8 2区 医学 Q1 ANESTHESIOLOGY
European Journal of Anaesthesiology Pub Date : 2025-11-01 Epub Date: 2025-08-21 DOI:10.1097/EJA.0000000000002258
Joana Berger-Estilita, Isabel Marcolino, Mia Gisselbaek, Christian Seidl, Thomas W Buehrer, Ines Fortuna, Basak C Meco, Finn M Radtke, Sarah Saxena
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引用次数: 0

Abstract

Background: Value-based healthcare emphasises patient-centred outcomes. However, Patient-Reported Outcomes Measures (PROMs) and Patient-Reported Experience Measures (PREMs) remain underused in peri-operative care. Postoperative delirium (POD) is a common and serious complication associated with increased morbidity and healthcare costs. Understanding the prognostic value of PROMs and PREMs may support identification and prevention of POD in the postoperative anaesthesia care unit (PACU).

Objectives: We assessed the association between peri-operative patient-reported symptoms and PACU POD using systematically collected PROMs and PREMs (including pain, anxiety, thirst, stress, and satisfaction), following the implementation of a brain protection care bundle.

Design: Prospective cohort study.

Setting: A single-centre study in a secondary-care private hospital in Switzerland from January 2023 to January 2024.

Patients: 1419 adults undergoing elective or urgent surgery. Exclusion criteria included age <18 years, inability to provide consent, language barriers, need for postoperative mechanical ventilation, or pre-operative Nursing Delirium Screening Scale (Nu-DESC > or equal to 2).

Interventions: Implementation of the Safe Brain Initiative (SBI) care bundle, incorporating 18 multidisciplinary, nonpharmacologic strategies to optimise peri-operative brain health.

Main outcome measures: The primary outcome was PACU POD incidence, assessed using the Nu-DESC at emergence and PACU discharge. Secondary outcomes included associations between PACU POD and pre-operative PROMs (pain, anxiety, stress, nausea) and PREMs (satisfaction, well being).

Results: PACU POD occurred in 19.6% of patients. Pre-operative anxiety (NRS > 7) was an independent predictor of POD ( P  = 0.012). Pre-operative PROMs showed increasing trends, while postoperative symptoms (pain, anxiety, nausea) significantly decreased. Patients with POD reported lower well being scores despite high satisfaction in other PREM domains.

Conclusions: Pre-operative anxiety and stress strongly predict PACU POD, supporting early risk stratification and targeted interventions. Integrating PROMs and PREMs into peri-operative workflows enhances patient-centred care.

患者报告的结果作为麻醉后护理病房术后谵妄的驱动因素:来自一年前瞻性队列研究的数据。
背景:基于价值的医疗保健强调以患者为中心的结果。然而,患者报告的结果测量(PROMs)和患者报告的体验测量(PREMs)在围手术期护理中的应用仍然不足。术后谵妄(POD)是一种常见且严重的并发症,与发病率和医疗费用增加有关。了解PROMs和PREMs的预后价值可能有助于在术后麻醉护理病房(PACU)中识别和预防POD。目的:我们评估围手术期患者报告的症状与PACU POD之间的关系,使用系统收集的PROMs和PREMs(包括疼痛、焦虑、口渴、压力和满意度),在实施脑保护护理包后。设计:前瞻性队列研究。背景:2023年1月至2024年1月在瑞士一家二级私立医院进行的单中心研究。患者:1419名接受选择性或紧急手术的成年人。排除标准包括年龄2岁。干预措施:实施安全脑倡议(SBI)护理包,包括18个多学科、非药物策略,以优化围手术期脑健康。主要结局指标:主要结局指标为PACU POD发生率,采用急诊和PACU出院时的Nu-DESC进行评估。次要结局包括PACU POD与术前PROMs(疼痛、焦虑、压力、恶心)和PREMs(满意度、幸福感)之间的关系。结果:PACU POD发生率为19.6%。术前焦虑(NRS >7)是POD的独立预测因子(P = 0.012)。术前PROMs呈增加趋势,而术后症状(疼痛、焦虑、恶心)明显减轻。POD患者报告了较低的幸福感得分,尽管在其他PREM领域满意度很高。结论:术前焦虑和应激可预测PACU POD,支持早期风险分层和有针对性的干预。将PROMs和PREMs整合到围手术期工作流程中可以增强以患者为中心的护理。试验注册:不适用;质量改进项目。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.90
自引率
11.10%
发文量
351
审稿时长
6-12 weeks
期刊介绍: The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).
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