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Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery

机译：大手术后重症监护病房住院期间术后del妄的结果和生活质量

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IntroductionDelirium is an acute disturbance of consciousness and cognition that has been shown to be associated with poor outcomes, including increased mortality. We aimed to evaluate outcome after postoperative delirium in a cohort of surgical intensive care unit (SICU) patients.MethodsThis prospective study was conducted over a 10-month period in a SICU. Postoperative delirium was diagnosed in accordance with the Intensive Care Delirium Screening Checklist (ICDSC). The primary outcome was mortality at 6-month follow-up. Hospital mortality and becoming dependent were considered as secondary outcomes, on the basis of the evaluation of the patient’s ability to undertake both personal and instrumental activities of daily living (ADL) before surgery and 6?months after discharge from the SICU. For each dichotomous outcome - hospital mortality, mortality at 6-month follow-up, and becoming dependent - a separate multiple logistic regression analysis was performed, which included delirium as an independent variable. Another outcome analyzed was changes in health-related quality of life, as determined using short-form 36 (SF-36), which was administered before and 6?months after discharge from the SICU. Additionally, for each SF-36 domain, a separate multiple linear regression model was used for each SF-36 domain, with changes in the SF-36 domain as a dependent variable and delirium as an independent variable.ResultsOf 775 SICU-admitted adults, 562 were enrolled in the study, of which 89 (16%) experienced postoperative delirium. Delirium was an independent risk factor for mortality at the 6-month follow-up (OR?=?2.562, P <0.001) and also for hospital mortality (OR?=?2.673, P <0.001). Delirium was also an independent risk factor for becoming dependent for personal ADL (P-ADL) after SICU discharge (OR?=?2.188, P <0.046). Moreover, patients who experienced postoperative delirium showed a greater decline in SF-36 domains after discharge, particularly in physical function, vitality, and social function, as compared to patients without postoperative delirium.ConclusionsPostoperative delirium was an independent risk factor for 6-month follow-up mortality, hospital mortality, and becoming independent in P-ADL after SICU discharge. It was also significantly associated with a worsening in the quality of life after surgery.
机译：简介ir妄是一种严重的意识和认知障碍，已证明与不良预后有关，包括死亡率增加。我们的目的是评估一组手术重症监护病房（SICU）患者术后del妄后的转归。方法该前瞻性研究在SICU中进行了10个月。根据重症监护Deli妄检查表（ICDSC）诊断出del妄。主要结局是随访6个月时的死亡率。根据对患者在手术前和出院后6个月进行日常个人和器械活动（ADL）的能力的评估，将医院的死亡率和依赖程度视为次要结果。对于每项二分式结局-医院死亡率，6个月随访时的死亡率以及因人而异-进行了单独的多元logistic回归分析，其中包括del妄作为独立变量。分析的另一个结果是与健康有关的生活质量的变化，这是通过使用短格式36（SF-36）确定的，该格式是在从SICU出院前和出院后6个月使用的。此外，对于每个SF-36域，对于每个SF-36域都使用了一个单独的多元线性回归模型，其中SF-36域的变化是因变量，independent妄是独立变量。结果：775名接受SICU的成年人，该研究共纳入562例，其中89例（16％）术后出现ir妄。妄是6个月随访时死亡的独立危险因素（OR≥2.562，P <0.001），也是医院死亡率（OR≥2.673，P <0.001）。 SI妄也是SICU出院后依赖个人ADL（P-ADL）的独立危险因素（OR？=？2.188，P <0.046）。此外，与没有术后ir妄的患者相比，发生术后del妄的患者出院后SF-36结构域下降更大，尤其是在身体功能，活力和社会功能方面。结论术后del妄是6个月随访的独立危险因素死亡率，住院死亡率，并在SICU出院后独立于P-ADL。它也与手术后生活质量的恶化显着相关。

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