Objective: Postoperative delirium (POD) is a common complication with a high health-related impact. The creation of a model (Siena posTopeRative dElirium in vaScular Surgery) to identify high-risk patients with consecutive prompt diagnosis and correct management.
Methods: This is an observational retrospective study to evaluate POD incidence in patients who underwent elective vascular surgery procedures between 2018 and 2020. POD was detected using CAM and defined as the onset of an acute confusional state, clinically manifesting as a disturbed state of consciousness, cognitive dysfunction, or alteration in perception and behavior. The total population was divided in the development and validation subsamples. Multivariable logistic regression analysis was performed, identifying variables related to the occurrence of POD. An additive score was created and the STRESS score was internally validated using the Validation subgroup.
Results: A total of 1067 patients were enrolled. POD occurred in 111 cases (10.4%). Multivariable logistic regression analysis for POD occurrence revealed as significant predictors: age>75 years, CKD, dyslipidaemia, psychiatric disease, CAD, hospitalization in the previous month, preoperative NLR >3.59, preoperative Hb < 12 g/dl, preoperative Barthel score <75, major amputation, CLTI revascularization, general anesthesia, and postoperative urinary catheter. These variables were used to create the STRESS score. The model was applied to both development and validation subgroups; AUC was respectively 0.7079 ( < .0001) and 0.7270 ( < .0001).
Conclusion: The STRESS score has a good predictive potentiality for POD occurrence in elective vascular surgery procedures. However, implementation and external validation are needed to be correctly used in everyday clinical practice.
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http://dx.doi.org/10.1177/17085381241236926 | DOI Listing |
Anesth Analg
December 2024
Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial Hospital, Fuzhou City, China.
Front Cardiovasc Med
December 2024
Department of Anaesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Justus-Liebig University Giessen, Giessen, Germany.
Introduction: Postoperative delirium (POD) after cardiac surgery significantly affects the perioperative morbidity and mortality. Butyrylcholinesterase (BChE) is an enzyme primarily produced in the liver, which plays a crucial role in the hydrolysis of acetylcholine outside of neuronal synapses, referred to as extraneuronal hydrolysis. The integration of BChE activity into the cardiac delirium (CARDEL) index might increase its predictive power for identifying POD after cardiac surgery.
View Article and Find Full Text PDFCureus
November 2024
Orthopaedics, Glasgow Royal Infirmary, Glasgow, GBR.
Osteoporosis is a major risk factor for fragility fractures. The British Orthopaedics Association Standards for Trauma and Orthopaedics (BOAST) and Getting it Right First Time (GIRFT) guidelines on fragility fracture management highlight the need to initiate prompt, coordinated multidisciplinary care with a focus on early mobilisation to improve patient outcomes. Medical management of fragility fractures focuses on the prevention of progressive frailty.
View Article and Find Full Text PDFInt J Gen Med
December 2024
Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China.
Purpose: The routine perioperative use of opioids has recently been questioned due to opioid-related side effects, which can be potentially harmful in geriatric patients. This study aimed to evaluate the effects of opioid-free anesthesia in geriatric patients undergoing hip surgery.
Patients And Methods: A total of 121 patients, aged 60 years or older, undergoing elective hip surgery were randomized to receive either opioid-free anesthesia with dexmedetomidine and esketamine (OFA group) or balanced anesthesia with opioids (CON group).
Intensive Crit Care Nurs
December 2024
Hangzhou Normal University, Department of Nursing, Zhejiang 311121, China. Electronic address:
Objectives: Analyze the effectiveness of different non-pharmacological sleep interventions in preventing delirium among postoperative ICU patients.
Research Methodology: We conducted a comprehensive search on PubMed, Cochrane Library, Web of Science, Embase, CINAHL, OpenGrey and reference lists up to May 2024.
Setting: We systematically searched all randomized controlled trials related to non-pharmacological sleep interventions for the prevention of delirium.
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