斯坦福研究介入前预防风险评估（PIPRA）工具在择期骨科手术高危老年患者中的有效性

IF 3.5 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research Pub Date : 2025-06-23 DOI:10.1016/j.jpsychores.2025.112196

Matthew Gunther , Derek Pipolo , Shixie Jiang , Tyler Zahrli , Jon Sole , Charles Cloughly , Jose R. Maldonado

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引用次数: 0

摘要

术后谵妄（POD）是老年人手术后常见的并发症，导致较高的发病率和死亡率。本研究评估介入前预防风险评估（PIPRA）工具在老年骨科人群中预测POD的有效性。方法纳入250例65岁及以上的择期骨科手术（膝关节或髋关节置换术）患者。谵妄的评估使用混淆评估法（CAM）和附加的基于DSM-5的神经精神评估。PIPRA工具可追溯应用，根据患者电子病历（EMR）中发现的9个经过验证的风险因素生成谵妄风险评分。结果241例患者中，13例（5.4%）发生POD。精神错乱患者的PIPRA评分中位数（24.3）明显高于非精神错乱患者（8.95）。Logistic回归发现年龄（OR = 1.12）和认知障碍史（OR = 10.38）是POD的重要预测因素。PIPRA工具显示曲线下面积（AUC）为0.748。我们的研究支持PIPRA在评估谵妄风险方面的有效性，使用患者emr中现成的临床参数。当整合到临床工作流程中时，该模型可以术前分层谵妄风险，使有针对性的干预措施能够预防其发作。结论PIPRA工具提供了一种评估手术人群POD风险的创新方法。通过识别高危患者，PIPRA可以促进知情同意的讨论和有效预防措施的实施。未来的研究应验证其在不同手术队列中的表现，以完善预测能力并优化谵妄预防策略。

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Stanford study of the validity of the pre-interventional preventive risk assessment (PIPRA) tool for at-risk elderly patients undergoing elective orthopedic surgery

Introduction

Post-operative delirium (POD) is a frequent complication in older adults following surgery, leading to higher morbidity and mortality. This study evaluates the validity of the Pre-Interventional Preventive Risk Assessment (PIPRA) tool in predicting POD in an elderly orthopedic population.

Methods

We enrolled 250 patients aged 65 or over undergoing elective orthopedic surgery (knee or hip arthroplasties). Delirium was assessed using the Confusion Assessment Method (CAM) and additional DSM-5 based neuropsychiatric evaluations. The PIPRA tool was applied retroactively to generate delirium risk scores based on nine validated risk factors found within the patient's electronic medical record (EMR).

Results

Of 241 patients, 13 (5.4 %) developed POD. The median PIPRA score for delirious patients was significantly higher (24.3) compared to non-delirious patients (8.95). Logistic regression identified age (OR = 1.12) and history of cognitive impairment (OR = 10.38) as significant predictors of POD. The PIPRA tool demonstrated an area under the curve (AUC) of 0.748.

Discussion

Our study supports PIPRA's validity in assessing delirium risk using readily available clinical parameters from patients' EMRs. When integrated into clinical workflows, this model can preoperatively stratify delirium risk, enabling targeted interventions to prevent its onset.

Conclusion

The PIPRA tool presents an innovative approach to evaluating POD risk in surgical populations. By identifying at-risk patients, PIPRA can facilitate informed consent discussions and the implementation of effective preventive measures. Future research should validate its performance across diverse surgical cohorts to refine predictive capabilities and optimize delirium prevention strategies.

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来源期刊

Journal of Psychosomatic Research 医学-精神病学

CiteScore

7.40

自引率

6.40%

发文量

314

审稿时长

6.2 weeks

期刊介绍： The Journal of Psychosomatic Research is a multidisciplinary research journal covering all aspects of the relationships between psychology and medicine. The scope is broad and ranges from basic human biological and psychological research to evaluations of treatment and services. Papers will normally be concerned with illness or patients rather than studies of healthy populations. Studies concerning special populations, such as the elderly and children and adolescents, are welcome. In addition to peer-reviewed original papers, the journal publishes editorials, reviews, and other papers related to the journal''s aims.