High ASA Physical Status and Low Serum Uric Acid to Creatinine Ratio are Independent Risk Factors for Postoperative Delirium Among Older Adults Undergoing Urinary Calculi Surgery

Abstract

Purpose This study was to investigate the incidence and potential predictive factors for postoperative delirium (POD) in older people following urinary calculi surgery, and to establish the corresponding risk stratification score by the significant factors to predict the risk of POD. Patients and Methods We retrospectively analyzed the perioperative data of 195 patients aged 65 or older who underwent elective urinary calculi surgery between September 2020 and September 2022. POD was defined by chart-based method, and the serum uric acid to creatinine (SUA/Cr) ratio as well as neutrophil-to-lymphocyte ratio (NLR) were calculated, respectively. Identification of the risk factors for POD was performed by univariate and multivariate logistic regression analysis. Moreover, the risk stratification score was developed based on the regression coefficients of the associated variables. Results In 195 eligible patients following urinary calculi surgery, the median age was 69 (66–72) and 19 patients ultimately developed POD (9.7%). The results by univariate analysis showed that patients with advanced age, high American Society of Anesthesiologists (ASA) physical status (≥3) and low SUA/Cr ratio (≤3.3) were more likely to develop POD, but dexmedetomidine can significantly decrease the risk of the occurrence of POD. The multivariate analysis further indicated that high ASA physical status (≥3) and low SUA/Cr ratio (≤3.3) were independently associated with POD, and the POD incidence could obviously be elevated with the increase of risk stratification score. Moreover, patients with delirium had longer hospital stays. Conclusion POD is frequent in geriatric patients following urinary calculi surgery (9.7%). The high ASA physical status (≥3) and low SUA/Cr ratio (≤3.3) were effective predictors of POD. The corresponding risk stratification based on these factors could be beneficial to determining patients who are susceptible to POD, and thus better preventing and reducing the occurrence of POD. However, large prospective studies are needed to confirm this finding.

Random forest algorithm for predicting postoperative delirium in older patients

“…In importance ranking, it can be intuitively seen that Creatinine, as a feature variable, has the greatest contribution to the predictive variable. Furthermore, through partial dependency graphs, POD occurrence probability was increased no matter when preoperative creatinine levels were lower or higher than normal, which is consistent with the published results ( 16 ), demonstrating that kidney function has an impact on brain cognitive ability. The possible reason is that metabolic disorders of renal function (abnormal levels of creatinine, etc.)…”

Nomogram for predicting of postoperative delirium in elderly patients undergoing radical esophagectomy

“…The ASA classi cation system is quick and easy to assess preoperative functional status. Differing signi cantly from patients with scores of 1 or 2, Patients with ASA classi cation ≥ 3 level often suffered more serious systemic diseases, impaired general physical status, higher incidence of postoperative complications and post-operative mortality [52][53][54][55]. Consistent with previous studys [56,57], we divided ASA scores into these two categories.…”

“…Surgery and anesthesia increased psychological and physical stress and the patient's preoperative physical condition plays an important role in postoperative recovery [58]. Combined effect of multiple comorbidities and decline in physiologic reserve in patients with higher ASA that increases susceptibility to POD [53,59].…”

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“…Whereas we found no statistically significant differences in common comorbidities such as diabetes and hypertension between the groups, it is considered that the cumulative impact of various comorbidities might heighten baseline vulnerability in older patients. This susceptibility, combined with the stress of surgery, could be a contributing factor to the development of POD 52 , 53 .…”