Risk Factors Investigation For Delirium After Spine Surgery In Elderly Patients

Background:Since 2000 China has entered an aging society,and in December of this year issued by the social sciences academics press ?China pension financial development report(2016)?found that people over the age of 65 in China reached 150 million in 2015,accounted for 11.6%,can be a peak in 2055,400 million people,accounted for 27.2%.With the increase of aging population,more and more common in spinal degenerative disease in clinical,spinal degenerative disease often manifest the symptom such as nerve root pain ? numbness ? walk instability,can seriously affect patients ' daily life.While solution is given priority with surgical treatment,so most of the elderly to avoid pain and accept spinal surgery.With the increase of surgery group,the incidence of spinal postoperative delirium in increasing,and increasingly brought to the attention of the orthopedic surgeon.Postoperative delirium increased postoperative management difficulty,medical expenses increased,hospitalized patients prolonged,the increasing cost of medical treatment and nursing,rehabilitation period extend,at the same time appear in the fracture ?hypostatic pneumonia?bedsore,such as increased risk of complications,and increased risk of developing Alzheimer's disease in the future,it hasbad influence on the family and society.In the treatment of delirium in hospitalized patients in the United States each year on the cost of about 4billion dollars,and the cost in not including the expenses for nursing and rehabilitation after discharge.The objective of this study was to analyze perioperative risk factors,screening delirium associated risk factors,provide theoretical basis for the prevention and treatment of postoperative delirium in clinical work.Objective:To explore the risk factors for delirium of the elderly patients after spinal operation.Screened in many factors including relatively controllable factors to take appreciate intervention measures,are positive significance for the prevention and treatment of delirium,providing theoretical basis for clinical work to cope with postoperative delirium.Methods:This study retrospectively reviewed 358 patients in Department of orthopedics,China-Japan union hospital of Jilin University between October 2015 and October 2016,aged more than 60 years who underwent spinal operation in venous inhalation anesthesia,with an average age of 66.3 years.Postoperative delirium was found in 37 patients.Of the 37 patients,30 were male and 7 Female.The following factors of patients' age,gender,Body Mass Index,whether the merger underlying diseases(hypertension,coronary heart disease,diabetes),surgical site,the duration of operation,amount of bleeding,the status of fever,hypoxemia and Laboratory Findings,were carried on the risk assessment by means of statistical analysis,to predict the responsibility rate for elderly spine patients with postoperative delirium.Results:Postoperative delirium developed in 37 patients,the incidence of postoperative delirium was 10.3%.Of the 37 patients,30 were male and 7were female,with an average age 72.73±5.25 years.The single factor risk analysis showed that there are significant differences between delirium and non-delirium in age(P<0.001)?gender(P=0.012)?operation duration(P<0.001)?operative site(P=0.007)?blood loss(P=0.034)?fever(P<0.001)and hypoxemia(P=0.006).Postoperative hemoglobin(P=0.036)? hematocrit(P=0.032)between patients with delirium and non-delirium group difference was statistically significant.While multiple factors Logistic regression analysis indicated that age(P<0.001)?operation duration(P<0.001)?fever(P<0.001)and hypoxemia(P=0.040)were the risk factors of delirium status after spinal surgery.Conclusion: Age,operative time,fever and hypoxemia are independent risk factors for postoperative patients undergoing spinal surgery.Shorten the operation time ? management of fever and avoid hypoxemia may contribute to reduce the incidence of postoperative delirium.