Scholarlink

Purpose <p>Both preoperative frailty and postoperative delirium (POD) are associated with higher risk of postoperative complications. But it is unclear if the effect of preoperative frailty on postoperative complications was mediated by POD.</p> Methods <p>This study was a mediation analysis of a pooled database. Patients aged ≥ 60&#xa0;years who underwent elective non-cardiac surgery were enrolled. Preoperative frailty was defined as the modified frailty index (mFI) ≥ 0.27. POD was assessed twice daily within the first 3&#xa0;days using the Confusion Assessment Method (CAM) for patients without intubation and the CAM for intensive care unit (CAM-ICU) for intubated patients. Major complications within postoperative 30&#xa0;days were screened. Mediation analysis was employed to explore the relationships between frailty, POD, and postoperative complications.</p> Results <p>A total of 4684 patients were included. The prevalence of frailty was 10.4% (489/4684). In comparison with non-frail patients, frail patients had a higher incidence of POD (12.7% [62/489] vs 6.5% [271/4195], RR = 2.102, 95% CI 1.568–2.819, <i>P</i> &lt; 0.001) and more postoperative complications (21.5% [105/489] vs 16.7% [701/4195], RR = 1.363, 95% CI 1.082–1.716, <i>P</i> = 0.008). The adjusted total and direct associations between frailty and postoperative complications were 5.8% (adjusted β, 95% CI, 1.8–9.5%; <i>P</i> &lt; 0.001) and 5.0% (adjusted β, 95% CI, 1.1–8.7%; <i>P</i> = 0.004), respectively. A significant indirect association via POD was observed (adjusted β = 0.8%; 95% CI, 0.3–1.4%; <i>P</i> &lt; 0.001), accounting for 13.8% of the total effect.</p> Conclusion <p>Preoperative frailty is associated with an increased risk of postoperative complications, mediated in part by early POD, in elderly patients following non-cardiac surgery. Given the modest effect size, further research is warranted to confirm these findings.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

The effect of delirium on the association between frailty and postoperative major complications in elderly patients: a mediation analysis

  • 期刊论文

  • 发表日期：

    2025年2月25日

查看全文
  • Ya-Fei Liu,
  • Fan Cui,
  • Xian Su,
  • Ya-Wei Li,
  • Yan Zhang,
  • Chun-Jing Li,
  • Dong-Liang Mu,
  • Dong-Xin Wang

摘要

Purpose

Both preoperative frailty and postoperative delirium (POD) are associated with higher risk of postoperative complications. But it is unclear if the effect of preoperative frailty on postoperative complications was mediated by POD.

Methods

This study was a mediation analysis of a pooled database. Patients aged ≥ 60 years who underwent elective non-cardiac surgery were enrolled. Preoperative frailty was defined as the modified frailty index (mFI) ≥ 0.27. POD was assessed twice daily within the first 3 days using the Confusion Assessment Method (CAM) for patients without intubation and the CAM for intensive care unit (CAM-ICU) for intubated patients. Major complications within postoperative 30 days were screened. Mediation analysis was employed to explore the relationships between frailty, POD, and postoperative complications.

Results

A total of 4684 patients were included. The prevalence of frailty was 10.4% (489/4684). In comparison with non-frail patients, frail patients had a higher incidence of POD (12.7% [62/489] vs 6.5% [271/4195], RR = 2.102, 95% CI 1.568–2.819, P < 0.001) and more postoperative complications (21.5% [105/489] vs 16.7% [701/4195], RR = 1.363, 95% CI 1.082–1.716, P = 0.008). The adjusted total and direct associations between frailty and postoperative complications were 5.8% (adjusted β, 95% CI, 1.8–9.5%; P < 0.001) and 5.0% (adjusted β, 95% CI, 1.1–8.7%; P = 0.004), respectively. A significant indirect association via POD was observed (adjusted β = 0.8%; 95% CI, 0.3–1.4%; P < 0.001), accounting for 13.8% of the total effect.

Conclusion

Preoperative frailty is associated with an increased risk of postoperative complications, mediated in part by early POD, in elderly patients following non-cardiac surgery. Given the modest effect size, further research is warranted to confirm these findings.