综合老年评估能否降低术后谵妄的发生率？一项针对接受经导管主动脉瓣植入术的老年人的准实验研究

IF 3.6 3区医学

Clinical Interventions in Aging Pub Date : 2024-02-28 DOI:10.2147/cia.s448167

Anna Schwesinger, Li-Tang Tsai, Wei Lang, Noemi Mantegazza, Robert Bauernschmitt, Markus Johannes Wilhelm, Heike Annette Bischoff-Ferrari, Michael Gagesch

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引用次数: 0

摘要

目的：经导管主动脉瓣植入术（TAVI）术后谵妄（POD）在老年人中很常见，并与多种不良后果相关，包括较高的死亡率。我们的目的是研究在 TAVI 术前进行老年病学综合评估 (CGA) 是否能降低 POD 的发生几率，并使自理能力发生积极变化，从而为今后的老年病学联合管理奠定基础：我们采用回顾性单中心研究的准实验设计，招募了在择期 TAVI 前接受 CGA 的 70 岁及以上患者，以及未进行术前 CGA 的非随机对比组。TAVI术后前5天的POD发生率（主要结果）和入院至出院期间自理能力指数（SPI）的变化（次要结果）数据由电子健康记录收集，CGA数据（暴露）由临床评估收集。为探讨(1)CGA与POD和(2)CGA与SPI之间的关系，采用了多变量逻辑回归和线性回归模型，并对年龄、性别、体重指数和药物数量进行了调整：在 435 名患者（平均年龄 81.0 ± 5.6 岁，女性占 43.6%，基线 SPI 中位数 [IQR] 40 [39, 40] 点）中，CGA 组 POD 发生率为 14.3%，非 CGA 组为 18.8%（P 0.219）。TAVI前接受CGA与POD几率（OR：1.15；95%CI：0.65- 2.04）或SPI改善（P 0.073）无关：我们观察到TAVI术前CGA与POD发生率或术后自我护理没有关系，这突出表明有必要进行更多研究，调查老年TAVI患者POD预防措施的效果，并将其纳入全面的老年病综合管理计划中：POPS、体弱老年人、围手术期护理、主动脉瓣狭窄、TAVI、谵妄

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Does Comprehensive Geriatric Assessment Reduce the Incidence of Postoperative Delirium? A Quasi-experimental Study in Older Adults Undergoing Transcatheter Aortic Valve Implantation

Purpose: Postoperative delirium (POD) after transcatheter aortic valve implantation (TAVI) is frequent in older adults and associated with multiple negative outcomes including a higher mortality. We aimed to investigate whether a comprehensive geriatric assessment (CGA) prior to TAVI reduces the odds of POD and results in a positive change in self-care ability, intended to lay a foundation for future geriatric comanagement.
Patients and methods: We used a retrospective, single-center study with a quasi-experimental design enrolling patients aged 70 years and older undergoing CGA before elective TAVI, and a nonrandomized comparison group without preoperative CGA. Data on POD occurrence during the first 5 days after TAVI (primary outcome) and change in self-care ability index (SPI) between admission and discharge (secondary outcome) were collected from electronic health records and CGA data (exposure) by clinical assessment. To explore associations between (1) CGA and POD, and (2) CGA and SPI, multivariate logistic regression and linear regression models were applied adjusting for age, sex, BMI, and number of medications.
Results: Among 435 patients (mean age 81.0 ± 5.6 years, 43.6% women, median [IQR] SPI at baseline 40 [39, 40] points), POD incidence was 14.3% in the CGA group vs 18.8% in the non-CGA group (P 0.219). Undergoing CGA before TAVI was not associated with the odds for POD (OR: 1.15; 95%CI: 0.65– 2.04) or improved SPI (P 0.073).
Conclusion: We observed no association of CGA prior to TAVI with POD incidence or postoperative self-care, highlighting the need for additional studies investigating the effect of POD preventive measures in older TAVI patients integrated into a comprehensive geriatric comanagement program.

Keywords: POPS, frail older adults, perioperative care, aortic stenosis, TAVI, delirium

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.