| Objective Enhanced recovery after surgery(ERAS)was first proposed by Kehlet in1997,ERAS is based on evidence-based medical,through multidisciplinary cooperation of surgery,anesthesia,nursing,etc.,to optimize perioperative clinical treatment path,so as to reduce postoperative complications,accelerate postoperative rehabilitation of patients,shorten the length of hospital stay.Postoperative delirium(POD)refers to an acute cognitive impairment that occurs within 1 week after surgery or before discharge.POD affects the prognosis of patients,increases the incidence of postoperative complications and prolongs patients’ hospital stay lengths.ERAS can reduce the risk of POD occurrence,but its implementation is difficult,and the influence of complete ERAS on POD is a comprehensive effect,and the relationship between a single ERAS pathway and POD has not been clearly studied.The purpose of this study was to evaluate the relationship between accelerated ERAS pathways and postoperative delirium in patients undergoing laparoscopic colorectal cancer resection.Methods A total of 927 patients,aged 45-80 yr,weighing 50-80 kg,ASA Grade I to II,undergoing laparoscopic colorectal cancer resection under general anesthesia combined with epidural anesthesia in Qingdao Municipal Hospital from June 2020 to September2022.Mini-mental state examination(MMSE)and Pittsburgh sleep quality index(PQSI)were used to evaluate preoperative cognitive function and sleep quality 1 day before surgery.Neuropsychological tests were conducted at the same time from 1 day after surgery to before discharge.confusion assessment method(CAM)and Memorial Delirium Assessment Scale(MDAS)were used to assess the occurrence and severity of POD.Patients were devided into delirium group or non-delirium group according to whether postoperation delirium occurred.1:4 matching was carried out according to the matching criteria of age difference of no more than 5 years,admission time difference of no more than 180 days,gender,operation and anesthesia time,MMSE score and education level.The baseline data of the two groups were compared.wald multifactor stepwise regression analysis was used to analyze whether there was a relationship between ERAS pathways and POD occurrence,and ERAS pathways that could independently affect POD occurrence were screened out.Results There were 132 cases in delirium group and 528 cases in non delirium group,Fourteen ERAS pathways were evaluated in all patients,There were significant differences in 8 ERAS pathways between two groups,intestinal preparation(P=0.032),nasogastric tube(P= 0.041)and urinary tube(P= 0.033)in group P were significantly higher than those in group NP,all of which were risk factors.In group P,nutritional support(P=0.047),intraoperative insulation(P= 0.049),The proportion of liquid heating(P=0.032)and postoperative analgesia(P=0.028)was significantly lower than that of NP group,both of which were protective factors.Multivariate regression analysis showed that PQSI score(95%CI 1.17-12.81),alcohol consumption history(95%CI 1.03-14.35),intestinal preparation(95%CI 1.49-14.32),and indenting-in naso-gastric tube(95%CI1.14-16.23)were independent risk factors for POD.Conclusion and Significance This study shows that avoidance of indenture nasogastric tube and bowel preparation are protective factors for POD,which can independently reduce the risk of POD occurrence.In future clinical work,avoidance of mechanical bowel preparation and indentured nasogastric tube can be fully utilized to prevent postoperative delirium.This study is expected to promote the study on the correlation between ERAS pathway and POD in various surgical methods,and timely intervention in postoperative delirium,leading to safer surgical care and better postoperative outcomes for patients. |
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