Metabolic syndrome and the risk of postoperative delirium and postoperative cognitive dysfunction: a multi-centre cohort study

Lipid dysregulation and delirium in older adults: A review of the current evidence and future directions

Delirium is a complex medical condition marked by acute episodes of cognitive dysfunction and behavioral disturbances, with a multifaceted etiology and challenging management across various clinical settings. Older adults, particularly in postoperative contexts, are at increased risk of developing delirium. Despite extensive research, a single underlying pathophysiological mechanism for delirium remains elusive. However, emerging evidence suggests a correlation between lipid dysregulation and delirium development in elderly patients, especially in postoperative settings. This connection has led to proposed treatments targeting dyslipidemia and associated neuroinflammatory effects in acute-phase delirium. This review aims to synthesize current literature on the relationship between lipid dysregulation and delirium in older adults, highlighting the need for further research into specific neurolipidome constituents and age-related lipid profile changes, potentially uncovering novel therapeutic strategies for delirium.

Predicting the Risk of Postoperative Delirium in Patients Undergoing Lobectomy: Development and Assessment of a Novel Nomogram

To construct and internally validate a nomogram predicting postoperative delirium (POD) in patients with pulmonary malignancies undergoing lobectomy.Clinical electronic medical record data were retrospectively collected from 1,066 patients who underwent lobectomy, divided into a training cohort (746) and a validation cohort (320) using a 7:3 temporal split. A nomogram for POD was developed using Lasso regression and multivariable logistic regression analysis according to the TRIPOD statement. Performance was assessed through receiver operating characteristic curves (ROC) and calibration plots.POD occurred in 203 patients (19.04%). The nomogram incorporated predictors such as age, body mass index (BMI), education level, history of diabetes, history of cerebrovascular disease, surgical approach, duration of surgery, and time to recovery from anesthesia. The area under the ROC curve (AUC) was 0.871 (95% confidence interval [CI]: 0.841-0.901) for the training cohort and 0.914 (95% CI: 0.877-0.951) for the validation cohort. Calibration curves demonstrated good agreement between predicted and actual probabilities in both cohorts.This novel nomogram can help clinicians and patients' families predict the likelihood of developing delirium following lobectomy, enabling the implementation of targeted prevention strategies.

A ketogenic diet decreases sevoflurane-induced burst suppression in rats

BACKGROUND

The brain requires a continuous fuel supply to support cognition and can get energy from glucose and ketones. Dysregulated brain metabolism is thought to contribute to perioperative neurocognitive disorders and anesthesia-induced burst suppression. Therefore, we investigated the relationship between brain metabolites and neurophysiology during the behavioral states of sleep and anesthesia under a standard diet (SD) or a ketogenic diet (KD).

METHODS

We measured prefrontal cortex glucose, lactate, and electroencephalogram in Fischer344 rats during spontaneous sleep/wake followed by 3 % sevoflurane anesthesia. Nine rats were fed a KD and 8 rats a SD. To assess the role of adenosine receptor-mediated ketone activity on burst suppression, 5 additional rats on the KD received an intraperitoneal injection of vehicle or the adenosine A1 receptor antagonist, DPCPX, before 3 % sevoflurane.

RESULTS

Sevoflurane induced larger fluctuations in glucose (p < 0.001) and lactate (p = 0.015) concentrations compared to sleep as measured by the standard deviation (glucose 0.085 mM and lactate 0.16 mM in sleep/wake and 0.25 mM and 0.41 mM during sevoflurane respectively). Changes in glucose and lactate were closely tied to electrophysiological oscillations. Animals on the KD had reduced burst suppression ratio (mean 10 % in KD vs 30 % in SD) (p = 0.007) as well as increased time to loss of movement (mean 14 min in KD vs 8 min in SD) (p = 0.003) compared to SD. DPCPX in KD rats showed a trend to increased burst suppression, reduced the time to start of burst suppression (45 min in KD+vehicle to 37 min KD+DPCPX) (p = 0.007), and increased duration of burst suppression (49 min in KD+vehicle to 90 min in KD+DPCPX) (p = 0.046) compared to KD+vehicle.

CONCLUSIONS

It is thought that anesthesia-induced burst suppression reflects an underlying deficiency in brain energy. Accordingly, we found that upregulating ketones, which increase available brain ATP levels, delayed anesthetic induction and decreased burst suppression consistent with the idea that the underlying metabolic state of the brain influences an anesthetic's effect on the brain. These findings suggest that metabolic interventions could be useful therapeutic targets to modulate brain activity during sleep and anesthesia. Future studies will examine whether ketones can reduce the cognitive symptoms associated with postoperative delirium.

Effect of parecoxib on postoperative delirium in patients with hyperlipidemia: a randomized, double-blind, single-center, superiority trial

BACKGROUND

Hyperlipidemia has been implicated in the higher risk of developing postoperative delirium. Prostaglandin endoperoxide synthase-2 mediates neuroinflammatory processes in postoperative delirium. This study aims to investigate whether preoperative administration of parecoxib is more efficient than a placebo in averting postoperative delirium in patients with hyperlipidemia.

MATERIALS AND METHODS

In this randomized, double-blind, superiority trial, participants with hyperlipidemia were randomized in a 1:1 ratio to receive parecoxib (40 mg parecoxib administered intravenously before anesthesia induction) or placebo (normal saline). The primary outcome was postoperative delirium incidence within three days, with a 5.4% difference set as the superiority threshold. Secondary outcomes were cumulative incidences of emergence delirium and prostaglandin endoperoxide synthase-2 levels, inflammatory cell counts, and pain score on postoperative day 1 and postoperative adverse events.

RESULTS

This trial conducted between August 2023 and August 2024 at a tertiary hospital in China included 452 adults with hyperlipidemia, with 226 in the parecoxib group and 226 in the placebo group. The incidence of postoperative delirium in the parecoxib group was 13.72%, a reduction of 12.39% compared to the placebo group (hazard ratio, 0.491; 95% confidence interval: 0.318 to 0.759; P < 0.001). The parecoxib group also had a lower incidence of emergence delirium, prostaglandin endoperoxide synthase-2 levels, white blood cell counts and neutrophil, and pain scores on postoperative day 1. The occurrence of adverse events was comparable between the two groups. Prostaglandin endoperoxide synthase-2 expression levels, white blood cell counts, and pain scores mediated the reduction of postoperative delirium incidence by parecoxib.

CONCLUSION

Parecoxib may help in reducing the hyperlipidemia-related postoperative delirium incidence. The effective anti-inflammatory activity of prostaglandin endoperoxide synthase-2 inhibition by parecoxib and postoperative pain control may be important mechanisms for preventing postoperative delirium.

Association between hyperlipidemia and postoperative delirium risk: a systematic review and meta-analysis

Introduction

The association between hyperlipidemia and its potential role as a risk factor for postoperative delirium (POD) remains unclear.

Methods

We systematically searched PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov to identify studies meeting the inclusion criteria. Outcomes of interest included comparisons of blood lipid levels between POD and non-POD (NPOD) patients, the association between hyperlipidemia and POD risk, and the predictive value of hyperlipidemia for POD.

Results

A total of nine studies involving 4,686 patients were included in the meta-analysis. Pooled analysis revealed that hyperlipidemia was significantly associated with an increased risk of POD (OR = 1.47; 95% CI 1.13-1.91; P = 0.004;) compared to patients without hyperlipidemia. Patients with POD exhibited significantly higher levels of total cholesterol (TC) (weighted mean difference [WMD] = 0.31; 95% CI 0.03-0.59; P = 0.030), triglycerides (TG) (WMD = 0.37; 95% CI 0.03-0.71; P = 0.033), and low-density lipoprotein cholesterol (LDL-C) (WMD = 0.09; 95% CI 0.01-0.17; P = 0.023) compared to NPOD patients. In contrast, high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in POD patients (WMD = -0.07; 95% CI -0.12 to -0.01; P = 0.026). Insufficient evidence was available to summarize the area under the curve (AUC) results.

Conclusions

Blood lipid levels were significantly elevated in POD patients compared to NPOD patients. Hyperlipidemia was significantly associated with an increased risk of POD, highlighting its potential role as a risk factor.

TREM2 Modulates Postoperative Cognitive Function in Aged Mice by Inhibiting the NLRP3/caspase-1 Pathway and Apoptosis via PLCγ2 Activation

Postoperative cognitive dysfunction (POCD) is a prevalent complication in elderly patients, with neuroinflammation identified as a key contributing factor. This study investigates the therapeutic potential of the TREM2-PLCγ2 signaling pathway in mitigating neuroinflammation, neuronal apoptosis and cognitive impairment following surgery. We employed both in vivo and in vitro models to investigate the effects of TREM2 activation and its interaction with PLCγ2. Mice subjected to surgery were pre-treated with the TREM2-activating peptide COG1410, and subsequently evaluated for neuroinflammation, neuronal apoptosis, and cognitive function. In vitro studies using microglial cells were conducted to examine the mechanistic relationship between TREM2 and PLCγ2 phosphorylation via SYK. Knockdown experiments and SYK inhibition were performed to determine the hierarchical interaction between TREM2, PLCγ2, and their downstream influence on the NLRP3 inflammasome. Surgery significantly elevated the activation of the NLRP3 inflammasome, along with increased Cleaved Caspase-1, IL-1β, IL-18, and neuronal apoptosis markers. Pre-treatment with COG1410 effectively reduced these pro-inflammatory and pro-apoptotic markers, while alleviating cognitive impairment. TREM2 activation promoted SYK-dependent phosphorylation of PLCγ2, which inhibited NLRP3 inflammasome activation and reduced neuroinflammation. TREM2 knockdown exacerbated microglial inflammation, while PLCγ2 knockdown suppressed NLRP3 activation. Inhibition of SYK impaired the protective effects of the TREM2-PLCγ2 pathway and delayed cognitive recovery in mice. RNA-sequencing further revealed significant alterations in pathways related to neuroinflammation and apoptosis. TREM2 modulates PLCγ2 activity through SYK phosphorylation, thereby alleviating microglial-driven neuroinflammation and neuronal apoptosis, and improving cognitive impairment following surgery. Targeting the TREM2-PLCγ2 pathway presents a promising strategy for the prevention and treatment of POCD.

The Effects of Hyperlipidemia on Postoperative Cognitive Dysfunction in Patients Undergoing Laparoscopic Gynecological Tumor Surgery

Background

POCD is a common postoperative complication associated with anesthesia and surgery. Its occurrence reduces the quality of life after surgery and increases the risk of death and disability. Related studies demonstrated that hyperlipidemia could affect the occurrence and development of patients' cognitive dysfunction. However, the association between hyperlipidemia and POCD has not been well examined.

Methods

A total of 98 patients were divided into hyperlipidemia group and normal lipid group based on blood lipid level. Minimum Mental State Examination was used to evaluate the preoperative cognitive status. The patients were assessed with the Montreal Cognitive Assessment 1 day before operation and 7 days after operation. The Telephone Interview for Cognitive Status-Modified was applied to evaluate the cognitive ability 1 and 3 months after surgery. We analyzed the incidence of POCD and its potential risk factors according to the scores on each scale after operation.

Results

A total of 98 patients including 52 patients in the hyperlipidemia group and 46 patients in the normal blood lipid group completed all postoperative follow-up. POCD occurred in 27 patients 7 days after surgery, including 19 patients (36.54%) in the hyperlipidemia group and 8 patients (17.39%) in the normal group. One month after surgery, 23 patients experienced POCD, with 17 (32.69%) in the hyperlipidemia group and 6 (13.04%) in the normal group. And three months after surgery, 20 patients experienced POCD, including 14 (26.92%) in the hyperlipidemia group and 6 (13.04%) in the normal group. Through univariate and multivariate regression analysis, we found that age and total cholesterol level were significantly associated with the occurrence of POCD.

Conclusion

Preoperative hyperlipidemia was associated with the occurrence of POCD 7 days and 1 month after laparoscopic gynecologic tumor surgery. Age and preoperative hypercholesterolemia were considered independent risk factors for POCD development.

The potential risk factors of postoperative cognitive dysfunction for endovascular therapy in acute ischemic stroke with general anesthesia

Background

Postoperative cognitive dysfunction (POCD) frequently occurs following endovascular therapy for acute ischemic stroke (AIS). Given the complexity of predicting AIS clinically, there is a pressing need to develop a preemptive prediction model and investigate the impact of anesthesia depth on AIS.

Methods

A total of 333 patients diagnosed with AIS were included in the study, comprising individuals with non-POCD (n = 232) or POCD (n = 101). Univariate and multivariate logistic regression analyses were utilized to examine the independent risk factors associated with POCD. A calibration, decision curve analysis, and precision-recall curves were employed to assess the model's goodness of fit.

Results

Multivariate regression analysis identified two inflammatory indicators, high-sensitivity C reactive protein (hs-CRP) and systemic immune inflammatory index (SII), and three brain injury indicators, National Institute of Health Stroke Scale (NIHSS) score, N-terminal pro-brain natriuretic peptide (NT-proBNP), and soluble protein-100 β (S100-β), which were used to construct a nomogram model.

Conclusion

The composite predictive model incorporating NIHSS score, hs-CRP, SII, NT-proBNP, and S100-β demonstrated efficacy in predicting POCD following AIS. Additionally, our results suggest a potential association between depth of anesthesia, cognitive impairment, and inflammatory response in AIS patients.

Different doses of dexmedetomidine combined with propofol for older adults undergoing cardiac surgery: the impact on postoperative delirium

OBJECTIVE

This study retrospectively investigated the effects of different doses of dexmedetomidine combined with propofol on postoperative delirium in older adults undergoing cardiac surgery.

METHODS

The medical records of 82 older adults undergoing cardiac surgery admitted to two hospitals between August 2019 and August 2022 were analyzed. The participants were divided into two groups based on the dexmedetomidine dose: group A (0.5 µg/kg dexmedetomidine + propofol) and group B (1.0 µg/kg dexmedetomidine + propofol). The mean arterial pressure (MAP), heart rate (HR), anesthesia depth index (NTI), and incidence of postoperative delirium (POD) at 7 days after surgery were compared.

RESULTS

MAP and HR were significantly higher in group A than in group B during extubation and 10 minutes after extubation and significantly higher than the values before anesthesia induction. At all time points post-anesthesia induction, NTI was higher in group B than in group A, and the incidence of POD within 7 days after surgery was significantly higher in group A. The Prince-Henry pain scores were higher in group A than in group B at 1, 4, 24, and 48 hours after surgery.

CONCLUSIONS

Higher dexmedetomidine doses were associated with more stable hemodynamics and stronger effects on POD in older adults undergoing cardiac surgery.

Cirsilineol improves anesthesia/surgery-induced postoperative cognitive dysfunction through attenuating oxidative stress and modulating microglia M1/M2 polarization

Background

Cirsilineol is a trimethoxy and dihydroxy flavonoid isolated from plant species such as Artemisia vestita and has a variety of pharmacological properties. This study analyzed whether cirsilineol could prevent postoperative cognitive dysfunction (POCD).

Methods

A POCD mouse model induced by anesthesia/surgery induction and a cell model established with hydrogen peroxide (H2O2)-induced microglia BV-2 were employed to explore the efficacy of cirsilineol on POCD. The cognition function of the mice were assessed by carrying out behavioral tests (Morris water maze test and Y-maze test). We assessed the activation and polarization status of microglia using immunofluorescence analysis and detected the expression levels of CD86 and CD206 using the quantitative PCR (qPCR). Subsequently, cell viability was determined by CCK-8 assay and apoptosis was assessed using Calcein-AM/PI staining. Meanwhile, superoxide dismutase (SOD) and malondialdehyde (MDA) levels in plasma and cell culture medium were detected using chemiluminescence. Finally, the phosphorylation levels of JAK/STAT signaling pathway-related proteins were analyzed by Western blot.

Results

Cirsilineol reduced the escape latency and times of crossing island and increased spontaneous alternation (SA) rate, restoring the cognitive dysfunctions of POCD-modeled mice. Meanwhile, POCD elevated CD86 expression and malondialdehyde content and lowered the level of SOD; however, cirsilineol promoted CD206 expression and generation of SOD and inhibited malondialdehyde production. In H2O2-induced microglia BV-2, cirsilineol treatment increased SOD content and suppressed the generation of reactive oxygen species (ROS) and malondialdehyde, modulating microglia M1/M2 polarization and JAK/STAT pathway.

Conclusion

Cirsilineol prevented against POCD by attenuating oxidative stress and modulating microglia M1/M2 polarization, providing novel insights for the management of POCD.

AI-Assisted Identification of Primary and Secondary Metabolomic Markers for Postoperative Delirium

Despite considerable investigative efforts, the molecular mechanisms of postoperative delirium (POD) remain unresolved. The present investigation employs innovative methodologies for identifying potential primary and secondary metabolic markers of POD by analyzing serum metabolomic profiles utilizing the genetic algorithm and artificial neural networks. The primary metabolomic markers constitute a combination of metabolites that optimally distinguish between POD and non-POD groups of patients. Our analysis revealed L-lactic acid, inositol, and methylcysteine as the most salient primary markers upon which the prediction accuracy of POD manifestation achieved AUC = 99%. The secondary metabolomic markers represent metabolites that exhibit perturbed correlational patterns within the POD group. We identified 54 metabolites as the secondary markers of POD, incorporating neurotransmitters such as gamma-aminobutyric acid (GABA) and serotonin. These findings imply a systemic disruption in metabolic processes in patients with POD. The deployment of gene network reconstruction techniques facilitated the postulation of hypotheses describing the role of established genomic POD markers in the molecular-genetic mechanisms of metabolic pathways dysregulation, and involving the identified primary and secondary metabolomic markers. This study not only expands the understanding of POD pathogenesis but also introduces a novel technology for the bioinformatic analysis of metabolomic data that could aid in uncovering potential primary and secondary markers in diverse research domains.

Postoperative delirium risk in patients with hyperlipidemia: A prospective cohort study

STUDY OBJECTIVE

Hyperlipidemia and postoperative delirium (POD) significantly affect patients' quality of life; however, the question of whether hyperlipidemia constitutes a risk factor for POD remain unclear. This study aimed to investigate whether patients with hyperlipidemia face elevated risks of developing POD and to identify potential causes for this increased risk.

DESIGN

A prospective cohort study.

SETTING

Operating room.

PATIENTS

Patients were adults scheduled for colorectal cancer surgery in 2023.

EXPOSURES

The exposure factor was hyperlipidemia, and the patients were divided into hyperlipidemia group and non-hyperlipidemia group.

MEASUREMENTS

POD occurrence within three days post-surgery was assessed using the 3-Minute Diagnostic Interview for Confusion Assessment Method. Over one year, these patients were monitored through telephone to evaluate their survival and cognitive function. Logistic regression analysis was performed to evaluate the risk factors for POD development in patients with hyperlipidemia and to construct a clinical prediction model.

MAIN RESULTS

This study included 555 patients. POD incidence was 21.6% in the hyperlipidemia group and 12.7% in the non-hyperlipidemia group. One year following surgery, patients with hyperlipidemia and POD exhibited significantly higher rates of mortality and cognitive decline than did those without POD (p < 0.001). A multifactorial logistic clinical prediction model was constructed from seven independent risk factors for POD development in patients with hyperlipidemia, including education, preoperative total cholesterol (TC), preoperative triglyceride (TG), diet, history of hypertension, Sedation-Agitation Scale, and postoperative trimethylamine N-oxide expression level, and it had the highest predictive value for POD development in patients with hyperlipidemia.

CONCLUSIONS

Compared with those without hyperlipidemia, patients with hyperlipidemia had higher POD incidence. Elevated serum TC and TG levels are independent risk factors for POD in patients with hyperlipidemia. The study's findings could help develop strategies for improving POD and hyperlipidemia treatment.

The association of pre-operative biomarkers of endothelial dysfunction with the risk of post-operative neurocognitive disorders: results from the BioCog study

INTRODUCTION

Endothelial dysfunction (ED) promotes the development of atherosclerosis, and studies suggest an association with age-related neurocognitive disorders. It is currently unclear whether ED is also associated with the risk of perioperative neurocognitive disorders.

METHOD

We included 788 participants aged ≥ 65 years of the BioCog study. Patients were scheduled to undergo elective surgery with expected duration > 60 min. Blood was collected before surgery for measurement of 5 biomarkers of ED: asymmetric and symmetric dimethylarginine (ADMA; SDMA), intercellular and vascular adhesion molecule (ICAM-1, VCAM-1), and von Willebrand factor (vWF). Patients were monitored for the occurrence of postoperative delirium (POD) daily until the 7th postoperative day. 537 (68.1%) patients returned for a 3-month follow-up. Post-operative cognitive dysfunction (POCD) was defined from the change in results on a battery of 6 neuropsychological tests between baseline and 3 months, compared to the change in results of a control group during the 3-month interval. The associations of each of the 5 ED biomarkers with POD and POCD respectively were determined using multiple logistic regression analyses with adjustment for age, sex, surgery type, pre-morbid IQ, body mass index, hypertension, diabetes, HbA1C, triglyceride, total and HDL cholesterol.

RESULTS

19.8% of 788 patients developed POD; 10.1% of 537 patients had POCD at 3 months. Concentrations of ED biomarkers were not significantly associated with a POD. A higher VCAM-1 concentration was associated with a reduced POCD risk (adjusted odds ratio 0.55; 95% CI: 0.35-0.86). No further statistically significant results were found.

CONCLUSION

Pre-operative concentrations of ED biomarkers were not associated with POD risk. We unexpectedly found higher VCAM-1 to be associated with a reduced POCD risk. Further studies are needed to evaluate these findings.

Incidence and Risk Factors of Delirium Following Brain Tumor Resection: A Retrospective National Inpatient Sample Database Study

OBJECTIVE

The aim of this study was to evaluate the occurrence and factors predisposing to delirium following brain tumor resection.

METHODS

Data from patients who underwent brain tumor resection surgery from 2016 to 2019 were extracted from the National Inpatient Sample database and retrospectively analyzed. The difference between the 2 groups was compared by Wilcoxon rank test or χ2 test was used. Univariate and multivariate logistic regression analyses were used to identify the risk factors of delirium after brain tumor resection.

RESULTS

From 2016 to 2019, 28,340 patients who underwent brain tumor resection were identified in the National Inpatient Sample database, with the incidence of delirium being 4.79% (1357/28,340). It was found that increased incidence of delirium was significantly associated with age over 75 years and males (all P < 0.001). Besides, patients with delirium were more likely to have multiple comorbidities and to receive elective surgery (all P < 0.001). The results of logistic regression analysis showed that self-pay (odds ratio [OR] = 0.51; confidence interval [CI] = 0.31-0.83; P = 0.007), elective admission (OR = 0.53; CI = 0.47-0.60; P < 0.001), obesity (OR = 0.77; CI = 0.66-0.92; P = 0.003), females (OR = 0.79; CI = 0.71-0.88; P < 0.001), and private insurance (OR = 0.80; CI = 0.67-0.95; P = 0.012) were associated with lower occurrence of delirium. Besides, delirium was related to extra total hospital charges (P < 0.001), increased length of stay (P < 0.001), higher inpatient mortality (P = 0.001), and perioperative complications (including heart failure, acute renal failure, urinary tract infection, urinary retention, septicemia, pneumonia, blood transfusion, and cerebral edema) (P < 0.001).

CONCLUSIONS

Many factors were associated with the occurrence of delirium after brain tumor resection. Therefore, clinicians should identify high-risk patients prone to delirium in a timely manner and take effective management measures to reduce adverse outcomes.

The Association of Plasma Leptin, Soluble Leptin Receptor and Total and High-Molecular Weight Adiponectin With the Risk of Perioperative Neurocognitive Disorders

BACKGROUND

Perioperative neurocognitive disorders (NCD) are poorly characterized in terms of their risk factor profiles. Leptin and adiponectin are adipose-tissue-derived hormones with a role in inflammation and atherosclerosis whose function in perioperative NCD is unclear. Here, we used a cohort of older adults to examine the association of preoperative plasma concentrations of these biomarkers with the risk of perioperative NCD.

METHODS

Prospective analysis of 768 participants aged ≥ 65 years of the BioCog study. Blood was collected before surgery for measurement of plasma total and high-molecular-weight (hmw) adiponectin, leptin, and soluble leptin receptor (sOB-R). The free leptin index (FLI, leptin:sOB-R) was calculated. Postoperative delirium (POD) was assessed twice daily until postoperative day 7/discharge. Five hundred twenty-six patients (68.5%) returned for 3-month follow-up and provided data on postoperative cognitive dysfunction (POCD). POCD was defined as a decline on six neuropsychological tests that exceeded that of a nonsurgical control group. Logistic regression analyses examined the associations of each exposure with POD and POCD risk, in separate models adjusted for age, sex, fasting, surgery type, and body mass index (BMI).

RESULTS

Of 768 patients, 152 (19.8%) developed POD. Of 526 attendants of the follow-up, 54 (10.3%) had developed POCD. Leptin, sOB-R, and total and hmw adiponectin were each not associated with POD. For POCD, we observed reduced risk in patients in FLI quartile 4 compared with quartile 1 (odds ratio, 0.26; 95% CI 0.08, 0.89). Sensitivity analyses for the outcome POD revealed statistically significant interaction terms of sOB-R and total adiponectin with obesity (BMI≥30kg/m2 versus BMI<30kg/m2). For the outcome POCD, a higher sOB-R was associated with an increased risk in the obese subgroup (odds ratio, 4.00; 95% CI 1.01, 15.86).

CONCLUSIONS

We did not find consistent evidence for the role of leptin, its receptor, and total and hmw adiponectin in POD and POCD risk. Future research should be used to support or refute our findings and to fully characterize any differences in the associations of these hormones with POD/POCD between obese and nonobese individuals.

Incidence and related risk factors for postoperative delirium following revision total knee arthroplasty: a retrospective nationwide inpatient sample database study

BACKGROUND

Postoperative delirium (POD) is a common surgical complication. However, the incidence and risk factors associated with postoperative delirium after revision total knee arthroplasty (rTKA) have not been comprehensively explored through extensive national databases.

METHODS

Utilizing the National Inpatient Sample (NIS), the largest comprehensive U.S. hospital healthcare database, we undertook a retrospective investigation involving 127,400 patients who underwent rTKA between 2010 and 2019. We assessed various aspects, including patient demographics, hospital characteristics, pre-existing medical conditions, and perioperative complications.

RESULTS

The overall incidence of postoperative delirium (POD) in patients undergoing rTKA between 2010 and 2019 was 0.97%. The highest incidence rate of 1.31% was recorded in 2013. Notably, this patient cohort demonstrated advanced age, increased burden of co-morbidities, prolonged hospital stays, increased hospitalization costs, and elevated in-hospital mortality rates (P < 0.001). Moreover, non-elective admissions, non-private insurance payments, and a preference for teaching hospitals were commonly observed among these patients. During their hospitalization, individuals who developed delirium subsequent to rTKA were more prone to experiencing certain perioperative complications. These complications encompassed medical issues like acute myocardial infarction, continuous invasive mechanical ventilation, postoperative shock, sepsis, stroke and other medical problems. Additionally, surgical complications including hemorrhage / seroma / hematoma, irrigation and debridement, prosthetic joint infection, periprosthetic fracture, and wound dehiscence / nonunion were noted. Several risk factors were found to be linked with the development of POD. These included advanced age (≥ 75 years), alcohol abuse, coagulation disorders, congestive heart failure, depression, fluid and electrolyte imbalances, and more. Conversely, female sex, having private insurance, and undergoing elective hospitalization emerged as protective factors against POD.

CONCLUSION

Our findings suggest that the general prevalence of POD in rTKA is relatively low according to NIS. There was a significant connection between the POD of rTKA and advanced age, prolonged length of stay (LOS), more in-patients' costs, higher in-hospital mortality rate, increased comorbidities, postoperative medical complications and postoperative surgical complications. This study helps to understand the risk factors associated with POD to improve poor outcomes.

How do we make progress in phenotyping patients with LUT such as OAB and underactive detrusor, including using urine markers and microbiome data, in order to personalize therapy? ICI-RS 2023: Part 1

INTRODUCTION

Overactive bladder (OAB) and Underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction.

OBJECTIVES

The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment.

METHODS

A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU investigating metabolic, neurogical, psychological and gastrointestinal aspects with the aim to personalize the treatment.

RESULTS AND CONCLUSIONS

The article emphasizes the critical significance of adopting a comprehensive yet tailored approach to phenotyping patients with lower urinary tract symptoms, such as OAB and UAB. The intricate interplay between the lower urinary tract and various factors, metabolic, neurological, psychological, and gastrointestinal can define unique LUT profiles, enabling personalized therapies to replace the one-size-fits-all approach.

Predictive value of the Naples prognostic score on postoperative delirium in the elderly with gastrointestinal tumors: a retrospective cohort study

BACKGROUND

Postoperative delirium (POD) is a common complication among elderly patients after surgery. The Naples Prognostic Score (NPS), a novel prognostic marker based on immune-inflammatory and nutritional status, was widely used in the assessment of the prognosis of surgical patients. However, no study has evaluated the relationship between NPS and POD. The aim of this article was to investigate the association between NPS and POD and test the predictive efficacy of preoperative NPS for POD in elderly patients with gastrointestinal tumors.

MATERIALS AND METHODS

In the present study, we retrospectively collected perioperative data of 176 patients (≥ 60 years) who underwent elective gastrointestinal tumor surgery from June 2022 to September 2023. POD was defined according to the chart-based method and the NPS was calculated for each patient. We compared all the demographics and laboratory data between POD and non-POD groups. Univariate and multivariate logistic regression analysis was used to explore risk factors of POD. Moreover, the accuracy of NPS in predicting POD was further assessed by utilizing receiver operating characteristic (ROC) curves.

RESULTS

20 had POD (11.4%) in a total of 176 patients, with a median age of 71 (65-76). The outcomes by univariate analysis pointed out that age, ASA status ≥ 3, creatinine, white blood cell count, fasting blood glucose (FBG), and NPS were associated with the risk of POD. Multivariate logistic regression analysis further showed that age, ASA grade ≥ 3, FBG and NPS were independent risk factors of POD. Additionally, the ROC curves revealed that NPS allowed better prognostic capacity for POD than other variables with the largest area under the curve (AUC) of 0.798, sensitivity of 0.800 and specificity of 0.667, respectively.

CONCLUSION

Age, ASA grade ≥ 3, and FBG were independent risk factors for POD in the elderly underwent gastrointestinal tumor surgery. Notably, the preoperative NPS was a more effective tool in predicting the incidence of POD, but prospective trials were still needed to further validate our conclusion.

TRIAL REGISTRATION

The registration information for the experiment was shown below. (date: 3rd January 2024; number: ChiCTR2400079459).

Risk factors of postoperative delirium following spine surgery: A meta-analysis of 50 cohort studies with 1.1 million participants

OBJECTIVES

Postoperative delirium (POD) is considered to be a common complication of spine surgery. Although many studies have reported the risk factors associated with POD, the results remain unclear. Therefore, we performed a meta-analysis to identify risk factors for POD among patients following spinal surgery.

METHODS

We systematically searched the PubMed, Embase and the Cochrane Library for relevant articles published from 2006 to February 1, 2023 that reported risk factors associated with the incidence of POD among patients undergoing spinal surgery. The Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed, and random effects models were used to estimate pooled odds ratio (OR) estimates with 95 % confidence intervals (CIs) for each factor. The evidence from observational studies was classified according to Egger's P value, total sample size, and heterogeneity between studies.

RESULTS

Of 11,329 citations screened, 50 cohort studies involving 1,182,719 participants met the inclusion criteria. High-quality evidence indicated that POD was associated with hypertension, diabetes mellitus, cardiovascular disease, pulmonary disease, older age (>65 years), patients experiencing substance use disorder (take drug ≥1 month), cerebrovascular disease, kidney disease, neurological disorder, parkinsonism, cervical surgery, surgical site infection, postoperative fever, postoperative urinary tract infection, and admission to the intensive care unit (ICU). Moderate-quality evidence indicated that POD was associated with depression, American Society of Anesthesiologists (ASA) fitness grade (>II), blood transfusion, abnormal potassium, electrolyte disorder, length of stay, inability to ambulate and intravenous fluid volume.

CONCLUSIONS

Conspicuous risk factors for POD were mainly patient- and surgery-related. These findings help clinicians identify high-risk patients with POD following spinal surgery and recognize the importance of early intervention.