Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study)
The objective was to determine the prognostic value of predictors of early postoperative cognitive disorders in traumatological patients to assess the development of the main clinical outcomes (postoperative delirium and delayed neurocognitive recovery).Materials and methods. A two-center prospectiv...
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| Format: | Article |
| Language: | Russian |
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New Terra Publishing House
2024-04-01
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| Series: | Вестник анестезиологии и реаниматологии |
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| Online Access: | https://www.vair-journal.com/jour/article/view/962 |
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| author | N. V. Ermokhina A. N. Kuzovlev D. V. Davydov A. V. Grechko P. A. Polyakov P. V. Ryzhkov T. S. Serkova E. A. Lukyanova D. V. Belokopytov V. V. Moroz |
| author_facet | N. V. Ermokhina A. N. Kuzovlev D. V. Davydov A. V. Grechko P. A. Polyakov P. V. Ryzhkov T. S. Serkova E. A. Lukyanova D. V. Belokopytov V. V. Moroz |
| author_sort | N. V. Ermokhina |
| collection | DOAJ |
| description | The objective was to determine the prognostic value of predictors of early postoperative cognitive disorders in traumatological patients to assess the development of the main clinical outcomes (postoperative delirium and delayed neurocognitive recovery).Materials and methods. A two-center prospective cohort observational study of patients aged 45–74 years after planned traumatological operations (endoprosthetics of large joints of the lower extremities, spinal fusion surgery, transpedicular fixation of vertebrae) under general anesthesia with tracheal intubation was conducted in the period from March 2021 to June 2022. Before the operation, demographic indicators, concomitant diseases, background therapy, laboratory tests and testing (ASA, MoCA, AUDIT, CFS, HADS-A, RASS). At the end of the operation after extubation and in the postoperative period, patients were analyzed according to the scales RUS, CAM- ICU and CAM-ICU-7, NRS and BPS. Statistical analysis was carried out using the software SPSS Statistics 27.0.1.0.Results. The study included 200 patients. Early postoperative cognitive disorders (ePCD) (agitation and emergence delirium (ED)) 61 (30.5%) patients were diagnosed, 139 (69.5%) patients had adequate awakening in the operating room. Independent predictors of the development of ePCD were the age of patients (≥ 60), glucose level ≥ 5.6 and a high score on the Clinical Frailty Scale (≥ 4). The prevalence of postoperative delirium (POD) was 11% (22 patients). The independent risk factors for POD were the duration of hypotension and the presence of hyperactive ED. Delayed neurocognitive recovery after surgery and anesthesia was observed in 115 patients (57.8%). At the same time, a statistically significant predictor of this condition was the duration of hypotension for more than 15 minutes (sensitivity 59.18%, specificity 65.85%).Conclusion. When comparing the influence of the study group (patients with ePCD) with the control group, it was determined that ePCD is an independent risk factor for the development of POD (p < 0.001). |
| format | Article |
| id | doaj-art-742da99623c240f583c6fb014cb6f682 |
| institution | Kabale University |
| issn | 2078-5658 2541-8653 |
| language | Russian |
| publishDate | 2024-04-01 |
| publisher | New Terra Publishing House |
| record_format | Article |
| series | Вестник анестезиологии и реаниматологии |
| spelling | doaj-art-742da99623c240f583c6fb014cb6f6822025-08-20T03:56:32ZrusNew Terra Publishing HouseВестник анестезиологии и реаниматологии2078-56582541-86532024-04-01212273810.24884/2078-5658-2024-21-2-27-38665Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study)N. V. Ermokhina0A. N. Kuzovlev1D. V. Davydov2A. V. Grechko3P. A. Polyakov4P. V. Ryzhkov5T. S. Serkova6E. A. Lukyanova7D. V. Belokopytov8V. V. Moroz9Federal Research Clinical Center of Reanimatology and Rehabilitation; Main Military Clinical Hospital named after academician N. N. BurdenkoFederal Research Clinical Center of Reanimatology and RehabilitationMain Military Clinical Hospital named after academician N. N. BurdenkoFederal Research Clinical Center of Reanimatology and RehabilitationFederal Research Clinical Center of Reanimatology and RehabilitationFederal Research Clinical Center of Reanimatology and RehabilitationI. M. Sechenov First Moscow State Medical University (Sechenov University)Pirogov Russian National Research Medical UniversityPirogov Russian National Research Medical UniversityFederal Research Clinical Center of Reanimatology and RehabilitationThe objective was to determine the prognostic value of predictors of early postoperative cognitive disorders in traumatological patients to assess the development of the main clinical outcomes (postoperative delirium and delayed neurocognitive recovery).Materials and methods. A two-center prospective cohort observational study of patients aged 45–74 years after planned traumatological operations (endoprosthetics of large joints of the lower extremities, spinal fusion surgery, transpedicular fixation of vertebrae) under general anesthesia with tracheal intubation was conducted in the period from March 2021 to June 2022. Before the operation, demographic indicators, concomitant diseases, background therapy, laboratory tests and testing (ASA, MoCA, AUDIT, CFS, HADS-A, RASS). At the end of the operation after extubation and in the postoperative period, patients were analyzed according to the scales RUS, CAM- ICU and CAM-ICU-7, NRS and BPS. Statistical analysis was carried out using the software SPSS Statistics 27.0.1.0.Results. The study included 200 patients. Early postoperative cognitive disorders (ePCD) (agitation and emergence delirium (ED)) 61 (30.5%) patients were diagnosed, 139 (69.5%) patients had adequate awakening in the operating room. Independent predictors of the development of ePCD were the age of patients (≥ 60), glucose level ≥ 5.6 and a high score on the Clinical Frailty Scale (≥ 4). The prevalence of postoperative delirium (POD) was 11% (22 patients). The independent risk factors for POD were the duration of hypotension and the presence of hyperactive ED. Delayed neurocognitive recovery after surgery and anesthesia was observed in 115 patients (57.8%). At the same time, a statistically significant predictor of this condition was the duration of hypotension for more than 15 minutes (sensitivity 59.18%, specificity 65.85%).Conclusion. When comparing the influence of the study group (patients with ePCD) with the control group, it was determined that ePCD is an independent risk factor for the development of POD (p < 0.001).https://www.vair-journal.com/jour/article/view/962postoperative cognitive disordersemergence deliriumagitationpostoperative deliriumdelayed neurocognitive recovery |
| spellingShingle | N. V. Ermokhina A. N. Kuzovlev D. V. Davydov A. V. Grechko P. A. Polyakov P. V. Ryzhkov T. S. Serkova E. A. Lukyanova D. V. Belokopytov V. V. Moroz Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study) Вестник анестезиологии и реаниматологии postoperative cognitive disorders emergence delirium agitation postoperative delirium delayed neurocognitive recovery |
| title | Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study) |
| title_full | Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study) |
| title_fullStr | Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study) |
| title_full_unstemmed | Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study) |
| title_short | Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study) |
| title_sort | prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries prospective cohort study |
| topic | postoperative cognitive disorders emergence delirium agitation postoperative delirium delayed neurocognitive recovery |
| url | https://www.vair-journal.com/jour/article/view/962 |
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