Development and Validation of a Postoperative Delirium Prediction Model for Elderly Orthopedic Patients in the Intensive Care Unit.

Gang Wang,Juan Zhou,Yingxin Hao,Huihui Zhu,Lei Zhang,Guangjian Chen,Ying Qi

doi:10.1155/2021/9959077

Abstract

We developed a prediction model for delirium in elderly patients in the intensive care unit who underwent orthopedic surgery and then temporally validated its predictive power in the same hospital. In the development stage, we designed a prospective cohort study, and 319 consecutive patients aged over 65 years from January 2018 to December 2019 were screened. Demographic characteristics and clinical variables were evaluated, and a final prediction model was developed using the multivariate logistic regression analysis. In the validation stage, 108 patients were included for temporal validation between January 2020 and June 2020. The effectiveness of the model was evaluated through discrimination and calibration. As a result, the prediction model contains seven risk factors (age, anesthesia method, score of mini-mental state examination, hypoxia, major hemorrhage, level of interleukin-6, and company of family members), which had an area under the receiver operating characteristics curve of 0.82 (95% confidence interval 0.76–0.88) and was stable after bootstrapping. The temporal validation resulted in an area under the curve of 0.80 (95% confidence interval 0.67–0.93). Our prediction model had excellent discrimination power in predicting postoperative delirium in elderly patients and could assist intensive care physicians with early prevention.

Highlights

Delirium, which is defined as an acute disorder of attention and cognition, is a common, life-threatening, and preventable clinical syndrome in older persons. e etiopathogenesis of delirium remains unclear [1]
Study Design. is was an observational study in which we developed a prediction model for delirium in elderly patients in the intensive care unit (ICU) who underwent orthopedic surgery and temporally validated it in a second prospective cohort in the same hospital. e inclusion criteria and study protocol were the same for both recruited groups. e study protocol was approved by the Clinical Research Ethics Committee of Tongji Hospital (2018-TJDX-176). e study protocol, including potential risks and benefits, was explained to patients in person before we obtained written informed consent from the patients or their legal representatives
We excluded patients who were delirious before admission to the ICU, stayed in the ICU for less than 24 h, were mechanically ventilated, had serious auditory or visual disorders, were severely mentally disabled, were unable to provide informed consent, or had the compliance rate of the delirium screening less than 80% during the ICU stay

Summary

Introduction

Delirium, which is defined as an acute disorder of attention and cognition, is a common, life-threatening, and preventable clinical syndrome in older persons. e etiopathogenesis of delirium remains unclear [1]. Delirium, which is defined as an acute disorder of attention and cognition, is a common, life-threatening, and preventable clinical syndrome in older persons. More than 2.6 million adults over 65 years develop delirium, accounting for an estimated expenditure over $164 billion in annual healthcare in the United States [4]. Delirium is one of the most common surgical complications among older patients, the incidence of which is between 15 and 25% after major elective procedures and approximately 50% after high-risk surgeries such as hip fracture repair and cardiac surgery [5]. E cumulative incidence of delirium exceeds 75% in patients undergoing mechanical ventilation in the intensive care unit (ICU) [6].

Methods

Results

Conclusion