Xiao-yi Hu MD, Hua-wei Duan MD, Lei-yuan Wang MD, Quan-fang Liu MD, Hao Yao MD, Da-qing Ma PhD, Dong-xin Wang PhD, Jian-jun Yang PhD, Mu-huo Ji PhD
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Oral swabs for oral microbiota analyses were collected before surgery. Subsequently, after propensity score matching, 21 samples from patients with postoperative delirium and 21 samples from patients without postoperative delirium were analyzed for oral microbiota. Our primary objective was to determine the association between oral frailty, changes in oral microbiota composition, and the occurrence of postoperative delirium.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Oral frailty emerged as an independent risk factor for postoperative delirium [HR = 1.75; 95% CI = (1.04–2.96); <i>p</i> = 0.035]. Additionally, patients with postoperative delirium demonstrated lower oral microbiota diversity, as indicated by a reduced Chao index compared with those without postoperative delirium (<i>p</i> = 0.034). A significant association was also found between the dysbiosis index and postoperative delirium (<i>p <</i> 0.001). ROC analysis revealed a pronounced area under the curve of 0.95 (95% CI: 0.88–1.00) for the dysbiosis index in predicting postoperative delirium. Subsequent Principal Coordinates and Kaplan–Meier analyses affirmed that both beta diversity and the dysbiosis index were significantly correlated with incidence of postoperative delirium, with <i>p</i>-values of 0.002 and <0.001, respectively. Furthermore, the interaction analysis through Cox proportional hazards regression suggested a combined effect of oral frailty and the dysbiosis index on the likelihood of developing postoperative delirium (<i>p</i> = 0.004).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Oral frailty and changes in oral microbiota among older adult patients undergoing non-cardiac surgery may influence the incidence of postoperative delirium.</p>\n </section>\n </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 3","pages":"812-823"},"PeriodicalIF":4.3000,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Associations between oral frailty, oral microbiota composition, and postoperative delirium in older adult patients\",\"authors\":\"Xiao-yi Hu MD, Hua-wei Duan MD, Lei-yuan Wang MD, Quan-fang Liu MD, Hao Yao MD, Da-qing Ma PhD, Dong-xin Wang PhD, Jian-jun Yang PhD, Mu-huo Ji PhD\",\"doi\":\"10.1111/jgs.19315\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Poor oral health, prevalent among the older adults, can undermine overall health and contribute to frailty. 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引用次数: 0
摘要
背景:口腔健康状况不佳,在老年人中普遍存在,会损害整体健康并导致身体虚弱。经历口腔脆弱和生态失调的老年人可能面临术后谵妄的高风险。本研究旨在探讨口腔脆弱及口腔菌群组成变化对老年非心脏手术患者术后谵妄发生的影响。方法:选取南京医科大学第二附属医院于2023年7月至2023年12月行非心脏手术的老年患者303例。术前采集口腔拭子进行口腔菌群分析。随后,经过倾向评分匹配,对21例术后谵妄患者和21例术后非谵妄患者的口腔微生物群进行分析。我们的主要目的是确定口腔脆弱、口腔微生物群组成变化和术后谵妄发生之间的关系。结果:口腔虚弱成为术后谵妄的独立危险因素[HR = 1.75;95% ci = (1.04-2.96);p = 0.035]。此外,术后谵妄患者口腔微生物群多样性较低,Chao指数较无术后谵妄患者降低(p = 0.034)。结论:接受非心脏手术的老年患者口腔脆弱和口腔微生物群的变化可能影响术后谵妄的发生率。
Associations between oral frailty, oral microbiota composition, and postoperative delirium in older adult patients
Background
Poor oral health, prevalent among the older adults, can undermine overall health and contribute to frailty. Older adults experiencing oral frailty and dysbiosis potentially face an elevated risk of postoperative delirium. This study aims to explore the influence of oral frailty and changes in oral microbiota composition on occurrence of postoperative delirium in older adult patients undergoing non-cardiac surgery.
Methods
A total of 303 older adult patients undergoing non-cardiac surgeries were recruited in the Second Affiliated Hospital of Nanjing Medical University from July 2023 to December 2023. Oral swabs for oral microbiota analyses were collected before surgery. Subsequently, after propensity score matching, 21 samples from patients with postoperative delirium and 21 samples from patients without postoperative delirium were analyzed for oral microbiota. Our primary objective was to determine the association between oral frailty, changes in oral microbiota composition, and the occurrence of postoperative delirium.
Results
Oral frailty emerged as an independent risk factor for postoperative delirium [HR = 1.75; 95% CI = (1.04–2.96); p = 0.035]. Additionally, patients with postoperative delirium demonstrated lower oral microbiota diversity, as indicated by a reduced Chao index compared with those without postoperative delirium (p = 0.034). A significant association was also found between the dysbiosis index and postoperative delirium (p < 0.001). ROC analysis revealed a pronounced area under the curve of 0.95 (95% CI: 0.88–1.00) for the dysbiosis index in predicting postoperative delirium. Subsequent Principal Coordinates and Kaplan–Meier analyses affirmed that both beta diversity and the dysbiosis index were significantly correlated with incidence of postoperative delirium, with p-values of 0.002 and <0.001, respectively. Furthermore, the interaction analysis through Cox proportional hazards regression suggested a combined effect of oral frailty and the dysbiosis index on the likelihood of developing postoperative delirium (p = 0.004).
Conclusions
Oral frailty and changes in oral microbiota among older adult patients undergoing non-cardiac surgery may influence the incidence of postoperative delirium.
期刊介绍:
Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.