Frailty index and its association with the onset of postoperative delirium in older adults undergoing elective surgery.

Humans Male Female Aged Frailty / diagnosis Emergence Delirium Delirium / diagnosis Frail Elderly Postoperative Complications / diagnosis Hand Strength Geriatric Assessment
Elective surgery Frailty Postoperative delirium

Journal

BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548

Informations de publication

Date de publication:
11 02 2023
Historique:
received: 23 08 2022
accepted: 30 11 2022
entrez: 11 2 2023
pubmed: 12 2 2023
medline: 15 2 2023
Statut: epublish

Résumé

The association of frailty based on the accumulation of deficits with postoperative delirium (POD) has been poorly examined. We aimed to analyze this association in older patients undergoing elective surgery. Preoperative data was used to build a 30-item frailty index (FI) for participants of the PAWEL-study. Delirium was defined by a combination of I-CAM and chart review. Using logistic regressions models we analysed the association between frailty and POD adjusting for age, sex, smoking, alcohol consumption, education and type of surgery. Among 701 participants (mean age 77.1, 52.4% male) median FI was 0.27 (Q1 0.20| Q3 0.34), with 528 (75.3%) frail participants (FI ≥ 0.2). Higher median FI were seen in orthopedic than cardiac surgery patients (0.28 versus 0.23), and in women (0.28 versus 0.25 in men). Frail participants showed a higher POD incidence proportion (25.4% versus 17.9% in non-frail). An increased odds for POD was observed in frail versus non-frail participants (OR 2.14 [95% CI 1.33, 3.44], c-statistic 0.71). A 0.1 increment of FI was associated with OR 1.57 [95% CI 1.30, 1.90] (c-statistic 0.72) for POD. No interaction with sex or type of surgery was detected. Adding timed-up-and-go-test and handgrip strength to the FI did not improve discrimination. Our data showed a significant association between frailty defined through a 30-item FI and POD among older adults undergoing elective surgery. Adding functional measures to the FI did not improve discrimination. Hence, our preoperative 30-item FI can help to identify patients with increased odds for POD. PAWEL and PAWEL-R (sub-) study were registered on the German Clinical Trials Register (number DRKS00013311 and DRKS00012797).

Sections du résumé

BACKGROUND
The association of frailty based on the accumulation of deficits with postoperative delirium (POD) has been poorly examined. We aimed to analyze this association in older patients undergoing elective surgery.
METHODS
Preoperative data was used to build a 30-item frailty index (FI) for participants of the PAWEL-study. Delirium was defined by a combination of I-CAM and chart review. Using logistic regressions models we analysed the association between frailty and POD adjusting for age, sex, smoking, alcohol consumption, education and type of surgery.
RESULTS
Among 701 participants (mean age 77.1, 52.4% male) median FI was 0.27 (Q1 0.20| Q3 0.34), with 528 (75.3%) frail participants (FI ≥ 0.2). Higher median FI were seen in orthopedic than cardiac surgery patients (0.28 versus 0.23), and in women (0.28 versus 0.25 in men). Frail participants showed a higher POD incidence proportion (25.4% versus 17.9% in non-frail). An increased odds for POD was observed in frail versus non-frail participants (OR 2.14 [95% CI 1.33, 3.44], c-statistic 0.71). A 0.1 increment of FI was associated with OR 1.57 [95% CI 1.30, 1.90] (c-statistic 0.72) for POD. No interaction with sex or type of surgery was detected. Adding timed-up-and-go-test and handgrip strength to the FI did not improve discrimination.
CONCLUSION
Our data showed a significant association between frailty defined through a 30-item FI and POD among older adults undergoing elective surgery. Adding functional measures to the FI did not improve discrimination. Hence, our preoperative 30-item FI can help to identify patients with increased odds for POD.
TRIAL REGISTRATION
PAWEL and PAWEL-R (sub-) study were registered on the German Clinical Trials Register (number DRKS00013311 and DRKS00012797).

Identifiants

DOI: 10.1186/s12877-022-03663-7 PMID: 36774453 PMC: PMC9921654
pubmed: 36774453
doi: 10.1186/s12877-022-03663-7
pii: 10.1186/s12877-022-03663-7
pmc: PMC9921654
doi:

Banques de données

DRKS
['DRKS00013311', 'DRKS00012797']

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

90

Informations de copyright

© 2023. The Author(s).

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Auteurs

Janina Steenblock (J)

Agaplesion Bethesda Clinic, Ulm, Germany.
Geriatric Center Ulm/Alb-Donau, Ulm, Germany.
Institute for Geriatric Research, University Clinic Ulm, Ulm, Germany.
Medical Faculty, Ulm University, Ulm, Germany.

Ulrike Braisch (U)

Agaplesion Bethesda Clinic, Ulm, Germany.
Geriatric Center Ulm/Alb-Donau, Ulm, Germany.
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.

Simone Brefka (S)

Agaplesion Bethesda Clinic, Ulm, Germany.
Geriatric Center Ulm/Alb-Donau, Ulm, Germany.
Institute for Geriatric Research, University Clinic Ulm, Ulm, Germany.

Christine Thomas (C)

Department of Old Age Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, Germany.
Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Freiburg, Germany.
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.

Gerhard W Eschweiler (GW)

Geriatric Center at the University Hospital Tuebingen, Tuebingen, Germany.

Michael Rapp (M)

Department of Social and Preventive Medicine, University of Potsdam, Am Neuen Palais 10, 14469, Potsdam, Germany.

Brigitte Metz (B)

Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany.

Christoph Maurer (C)

Center for Geriatric Medicine and Gerontology, University of Freiburg, Freiburg im Breisgau, Germany.

Christine A F von Arnim (CAF)

Department of Geriatrics, University Medical Center Göttingen, Göttingen, Germany.

Matthias L Herrmann (ML)

Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Freiburg, Germany.
Geriatric Center at the University Hospital Tuebingen, Tuebingen, Germany.

Sören Wagner (S)

Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.
Department of Anaesthesiology, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.

Michael Denkinger (M)

Agaplesion Bethesda Clinic, Ulm, Germany.
Geriatric Center Ulm/Alb-Donau, Ulm, Germany.
Institute for Geriatric Research, University Clinic Ulm, Ulm, Germany.
Medical Faculty, Ulm University, Ulm, Germany.

Dhayana Dallmeier (D)

Agaplesion Bethesda Clinic, Ulm, Germany. ddallmei@bu.edu.
Geriatric Center Ulm/Alb-Donau, Ulm, Germany. ddallmei@bu.edu.
Medical Faculty, Ulm University, Ulm, Germany. ddallmei@bu.edu.
Department of Epidemiology, Boston University School of Public Health, Boston, USA. ddallmei@bu.edu.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Frailty index and its association with the...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Frailty index and its association with the...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Fragilité › Frailty index and its association with the...
questionsmedicales.fr › Troubles mentaux › Troubles neurocognitifs › Délire avec confusion › Délire d'émergence › Frailty index and its association with the...
questionsmedicales.fr › Troubles mentaux › Troubles neurocognitifs › Délire avec confusion › Frailty index and its association with the...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Personne âgée fragile › Frailty index and its association with the...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Frailty index and its association with the...
questionsmedicales.fr › Phénomènes physiologiques de l'appareil locomoteur et du système nerveux › Phénomènes physiologiques du système locomoteur › Force musculaire › Force de la main › Frailty index and its association with the...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Évaluation gériatrique › Frailty index and its association with the...