Predictors of Postoperative Delirium in Non-Intensive Care Unit Elderly Spinal Surgery Patients: The Impact of Diabetes and Early Postoperative Pain.

Abstract

To explore the risk factors for postoperative delirium (POD) in elderly patients after spinal surgery. The clinical data of 1035 elderly patients (aged ≥65 years) who underwent spinal surgery were analyzed from January 2018 to December 2022 at the Department of Spinal Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei. This study focused on patients at the ward level (non-intensive care unit patients). POD was assessed using the confusion assessment method. Patients were divided into 2 groups on the basis of whether POD occurred: the POD group (group A) and the non-POD group (group B). The variables included patient characteristics, baseline symptoms, and operation-related factors. Risk factors were identified using univariate and multivariate logistic regression analyses. POD occurred in 116 of the 1035 patients included in the study, with an incidence rate of 11%. Univariate analysis revealed significant differences in age, emergency surgery, waiting days from admission to surgery (more than 3 days), diabetes status, preoperative cognitive dysfunction, operation time, intraoperative hypotension (systolic blood pressure [SBP] < 80 mmHg), and post-anesthesia care unit-visual assessment score (PACU-VAS) score between group A and group B (P < 0.05). Multivariate logistic regression analysis revealed that age (odds ratio [OR = 1.133, 95% confidence interval [CI]: 1.109-1.267, P = 0.017), emergency surgery (OR = 2.527, 95% CI: 1.207-5.624, P = 0.012), diabetes (OR = 1.532, 95% CI: 1.012-2.321, P = 0.043), preoperative cognitive dysfunction (OR = 3.239, 95% CI: 1.529-9.092, P = 0.018), operation time (OR = 1.019, 95% CI: 1.008-1.027, P = 0.002), intraoperative hypotension (SBP < 80 mmHg; OR = 2.105, 95% CI: 1.141-2.342, P = 0.014), and PACU-VAS (OR = 1.907, 95% CI: 1.265-2.334, P = 0.021) were positively correlated with POD in elderly patients after spinal surgery. While the factor "waiting days from admission to surgery (more than 3 days)" was associated with POD in the univariate analysis, it was not retained as an independent risk factor in the final multivariate model. Advanced age, emergency surgery, diabetes, preoperative cognitive dysfunction, long operation time, intraoperative hypotension (SBP<80 mmHg), and a PACU-VAS score ≥4 were independent risk factors for POD in elderly patients after spinal surgery. In the perioperative period, reasonable and effective measures should be taken according to risk factors to reduce the incidence of POD in elderly patients after spinal surgery.