{"title":"择期手术老年患者COVID-19病史与术后谵妄的相关性：一项前瞻性、双中心观察队列研究","authors":"Wen Duan, Jin-Jin Yang, Pan-Pan Fang, Wen-Jie Zhu, Yue Zhang, Xin-Yu Li, Da-Qing Ma, Yang-Yang Shan, Xue-Sheng Liu, Jian-Jun Yang","doi":"10.1007/s44254-025-00088-4","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>An increased incidence of delirium was reported in patients especially in elderly patient during the acute phase of coronavirus disease 2019 (COVID-19). However, whether COVID-19 history increases the risk of postoperative delirium (POD) in elderly patients remains unclear. This study aims to investigate the association between COVID-19 history and POD in elderly patients undergoing elective surgeries.</p><h3>Methods</h3><p>In this prospective, two center cohort study, 500 elderly patients undergoing elective surgeries from March to May 2023 were analyzed. The primary exposure was a history of COVID-19. The primary outcome was POD assessed with 3-min diagnostic confusion assessment method or confusion assessment method for the intensive care unit within three days after surgery. We used inverse probability of treatment weighting (IPTW) to balance the differences between patients with or without a history of COVID-19. The association between COVID-19 history and POD was estimated using a logistic regression model with IPTW. Additionally, we next exploringly conducted subgroup analysis and assessed interaction effects to evaluate the impact of COVID-19 history on POD based on frailty/pre-frailty, cancer, surgical type/classification, sex, profession, and residence type.</p><h3>Results</h3><p>In this cohort, 412 patients had a history of COVID-19 with an incidence 16% of POD while 88 were uninfected with 15.9% of POD incidence. There was no association between COVID-19 history and POD [adjusted odds ratio (OR<sub>adj</sub>) 1.20 (0.80–1.79), <i>P</i> = 0.378] in elderly patients undergoing elective surgery. However, POD was significantly increased in patients with COVID-19 history who were pre-frailty/frailty or with cancers [OR<sub>adj</sub> 2.41 (1.19–5.10) and OR<sub>adj</sub> 2.29 (1.23–4.39), respectively].</p><h3>Conclusion</h3><p>This preliminary exploratory study found no association between a history of COVID-19 and POD in elderly patients undergoing elective surgery.</p><h3>Trial registration</h3><p>Registered at the Chinese Clinical Trial Center (https://www.chictr.org.cn/showproj.html?proj=192846) with No. ChiCTR2300069308 on Mar 13, 2023.</p></div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"3 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-025-00088-4.pdf","citationCount":"0","resultStr":"{\"title\":\"Association between COVID-19 history and postoperative delirium in elderly patient undergoing elective surgery: a prospective, two-center observational cohort study\",\"authors\":\"Wen Duan, Jin-Jin Yang, Pan-Pan Fang, Wen-Jie Zhu, Yue Zhang, Xin-Yu Li, Da-Qing Ma, Yang-Yang Shan, Xue-Sheng Liu, Jian-Jun Yang\",\"doi\":\"10.1007/s44254-025-00088-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>An increased incidence of delirium was reported in patients especially in elderly patient during the acute phase of coronavirus disease 2019 (COVID-19). However, whether COVID-19 history increases the risk of postoperative delirium (POD) in elderly patients remains unclear. This study aims to investigate the association between COVID-19 history and POD in elderly patients undergoing elective surgeries.</p><h3>Methods</h3><p>In this prospective, two center cohort study, 500 elderly patients undergoing elective surgeries from March to May 2023 were analyzed. The primary exposure was a history of COVID-19. The primary outcome was POD assessed with 3-min diagnostic confusion assessment method or confusion assessment method for the intensive care unit within three days after surgery. We used inverse probability of treatment weighting (IPTW) to balance the differences between patients with or without a history of COVID-19. The association between COVID-19 history and POD was estimated using a logistic regression model with IPTW. Additionally, we next exploringly conducted subgroup analysis and assessed interaction effects to evaluate the impact of COVID-19 history on POD based on frailty/pre-frailty, cancer, surgical type/classification, sex, profession, and residence type.</p><h3>Results</h3><p>In this cohort, 412 patients had a history of COVID-19 with an incidence 16% of POD while 88 were uninfected with 15.9% of POD incidence. There was no association between COVID-19 history and POD [adjusted odds ratio (OR<sub>adj</sub>) 1.20 (0.80–1.79), <i>P</i> = 0.378] in elderly patients undergoing elective surgery. However, POD was significantly increased in patients with COVID-19 history who were pre-frailty/frailty or with cancers [OR<sub>adj</sub> 2.41 (1.19–5.10) and OR<sub>adj</sub> 2.29 (1.23–4.39), respectively].</p><h3>Conclusion</h3><p>This preliminary exploratory study found no association between a history of COVID-19 and POD in elderly patients undergoing elective surgery.</p><h3>Trial registration</h3><p>Registered at the Chinese Clinical Trial Center (https://www.chictr.org.cn/showproj.html?proj=192846) with No. ChiCTR2300069308 on Mar 13, 2023.</p></div>\",\"PeriodicalId\":100082,\"journal\":{\"name\":\"Anesthesiology and Perioperative Science\",\"volume\":\"3 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-02-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://link.springer.com/content/pdf/10.1007/s44254-025-00088-4.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Anesthesiology and Perioperative Science\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://link.springer.com/article/10.1007/s44254-025-00088-4\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anesthesiology and Perioperative Science","FirstCategoryId":"1085","ListUrlMain":"https://link.springer.com/article/10.1007/s44254-025-00088-4","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的观察新型冠状病毒病（COVID-19）急性期谵妄的发生率增高，尤其是老年患者。然而，COVID-19病史是否会增加老年患者术后谵妄（POD）的风险尚不清楚。本研究旨在探讨老年择期手术患者COVID-19病史与POD的关系。方法对2023年3月至5月接受择期手术的500例老年患者进行前瞻性、双中心队列研究。初次接触是COVID-19病史。主要终点为术后3天内用3 min诊断混淆评估法或重症监护病房混淆评估法评估POD。我们使用治疗加权逆概率（IPTW）来平衡有或没有COVID-19病史的患者之间的差异。使用IPTW的逻辑回归模型估计COVID-19病史与POD之间的关联。此外，我们接下来探索性地进行亚组分析并评估相互作用效应，以评估COVID-19病史对POD的影响，该影响基于虚弱/虚弱前、癌症、手术类型/分类、性别、职业和居住类型。结果412例患者有COVID-19病史，POD发生率为16%；88例患者未感染，POD发生率为15.9%。择期手术老年患者的COVID-19病史与POD无相关性[调整优势比（ORadj） 1.20 (0.80-1.79), P = 0.378]。然而，有COVID-19病史的虚弱前/虚弱或癌症患者的POD显著增加[ORadj 2.41（1.19-5.10）和ORadj 2.29(1.23-4.39)]。结论本初步探索性研究未发现老年择期手术患者的COVID-19病史与POD之间存在关联。试验注册：在中国临床试验中心注册（https://www.chictr.org.cn/showproj.html?proj=192846），注册号：2023年3月13日，ChiCTR2300069308。
Association between COVID-19 history and postoperative delirium in elderly patient undergoing elective surgery: a prospective, two-center observational cohort study
Purpose
An increased incidence of delirium was reported in patients especially in elderly patient during the acute phase of coronavirus disease 2019 (COVID-19). However, whether COVID-19 history increases the risk of postoperative delirium (POD) in elderly patients remains unclear. This study aims to investigate the association between COVID-19 history and POD in elderly patients undergoing elective surgeries.
Methods
In this prospective, two center cohort study, 500 elderly patients undergoing elective surgeries from March to May 2023 were analyzed. The primary exposure was a history of COVID-19. The primary outcome was POD assessed with 3-min diagnostic confusion assessment method or confusion assessment method for the intensive care unit within three days after surgery. We used inverse probability of treatment weighting (IPTW) to balance the differences between patients with or without a history of COVID-19. The association between COVID-19 history and POD was estimated using a logistic regression model with IPTW. Additionally, we next exploringly conducted subgroup analysis and assessed interaction effects to evaluate the impact of COVID-19 history on POD based on frailty/pre-frailty, cancer, surgical type/classification, sex, profession, and residence type.
Results
In this cohort, 412 patients had a history of COVID-19 with an incidence 16% of POD while 88 were uninfected with 15.9% of POD incidence. There was no association between COVID-19 history and POD [adjusted odds ratio (ORadj) 1.20 (0.80–1.79), P = 0.378] in elderly patients undergoing elective surgery. However, POD was significantly increased in patients with COVID-19 history who were pre-frailty/frailty or with cancers [ORadj 2.41 (1.19–5.10) and ORadj 2.29 (1.23–4.39), respectively].
Conclusion
This preliminary exploratory study found no association between a history of COVID-19 and POD in elderly patients undergoing elective surgery.
Trial registration
Registered at the Chinese Clinical Trial Center (https://www.chictr.org.cn/showproj.html?proj=192846) with No. ChiCTR2300069308 on Mar 13, 2023.
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