The elderly patients have poorer overall conditions and have lower tolerance to trauma, anesthesia, and surgery. Therefore, the incidence of postoperative complications is relatively higher. In non-cardiac surgeries, approximately 20% of elderly patients experience postoperative complications, and the incidence of postoperative delirium (POD) is 23.8%. This may lead to prolonged hospital stays, increased hospital costs, and affect prognosis and even mortality. The investigators plan to conduct a prospective cohort study by systematically collecting biological samples and clinical information of elderly patients during the perioperative period to explore the possible risk factors and pathogenesis of postoperative delirium and postoperative complications in elderly surgical patients, and to construct a risk prediction model for postoperative complications.
Study Type
OBSERVATIONAL
Enrollment
1,200
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
Wenzhou, Zhejiang, China
RECRUITINGIncidence of postoperative delirium (POD) within 7 days after surgery
POD is diagnosed daily using the Three-Minute Diagnostic Confusion Assessment Method (3D-CAM).
Time frame: Preoperative, during the first 7 postoperative days
The types of postoperative delirium
The type of delirium is assessed using the Richmond Agitation-Sedation Scale (RASS). The Richmond Agitation-Sedation Scale (RASS) is a 10-point scale ranging from -5 (unarousable) to +4 (combative). A score of +4 represents a combative state where the patient is violent and poses immediate danger, while a score of -5 indicates no response to any stimulus. Based on the RASS score, delirium can be categorized into three motoric subtypes: Hyperactive delirium: RASS scores consistently between +1 and +4. Hypoactive delirium: RASS scores consistently between 0 and -3. Mixed-type delirium: RASS scores that fluctuate between positive and negative values over the observation period.
Time frame: Preoperative, during the first 7 postoperative days
The severity of postoperative delirium
The severity of postoperative delirium will be assessed using the Confusion Assessment Method-Severity scale (CAM-S).
Time frame: Preoperative, during the first 7 postoperative days
The duration of postoperative delirium
Duration is defined as the number of days from the onset of delirium symptoms to symptom resolution or hospital discharge, whichever occurs first.
Time frame: Preoperative, during the first 7 postoperative days
Postoperative neurocognitive dysfunction
Neurocognitive decline is assessed by comparing baseline to postoperative scores on: Mini-Mental State Examination (MMSE, 0-30, higher=better function), Montreal Cognitive Assessment (MoCA, 0-30, higher=better function); and five neuropsychological tests-Clock Drawing Test, (DST, 0-16, higher=better attention), Trail Making Test Parts A and B (TMT-A/B, seconds, lower=better), Boston Naming Test (BNT, 0-30, higher=better naming), Auditory Verbal Learning Test - Huashan version (AVLT-H delayed recall, 0-10, higher=better memory), and Clock Drawing Test (CDT, 0-10, higher=better visuospatial/executive function). Patient/caregiver reports are also collected.
Time frame: preoperative baseline, within 7 days postoperatively, and at 1, 6, and 12 months postoperatively.
Acute pain
Using Visual Analogue Scale (VAS), 0-100, 0 means no pain, 100 means severe pain
Time frame: Preoperative and 3 days postoperative.
Hospital Anxiety and Depression Scale (HADS) score
The Hospital Anxiety and Depression Scale (HADS) is used for assessment, with each subscale (anxiety or depression) scored from 0-21: "0-7: Non-case", "8-10: Doubtful case", "11-21: Definite case". Higher scores clearly indicate worse outcomes, i.e., more severe anxiety or depression symptoms.
Time frame: preoperative, 5 days, 1 month, 6 months, and 1 year postoperative.
Activity of Daily Living
The Activities of Daily Living (ADL) are typically assessed using the Barthel Index. 0-100. A higher score indicates stronger independence: a score of 100 represents complete independence; a score of 61-99 suggests mild functional impairment with basic self-care ability; and a score of ≤40 indicates severe functional impairment, with significant or complete reliance on others for daily living.
Time frame: preoperative, 5 days, 1 month, 6 months, and 1 year postoperative.
Sleep quality
Sleep quality is assessed using the Pittsburgh Sleep Quality Index (PSQI). The total score ranges from 0 to 21 points. A score greater than 7 (\>7) is typically considered the clinical cutoff for poor sleep quality. A higher score indicates poorer sleep quality.
Time frame: preoperative, 5 days, 1 month, 6 months, and 1 year postoperative.
The FRAIL Scale
The FRAIL (Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight) Scale ranges from 0 to 5. A score of 0 indicates robust/non-frail status, scores of 1-2 indicate pre-frail status, and scores of 3-5 indicate frail status.
Time frame: preoperative, 5 days, 1 month, 6 months, and 1 year postoperative.
Quality of Life Score
using EQ-5D(Score of EuroQol Five Dimensions Questionnaire (EQ-5D)) to measure quality of life
Time frame: preoperative, 1 month, 6 months, and 1 year postoperative.
Mortality
In-hospital mortality; 30-day postoperative mortality; 1-year postoperative mortality
Time frame: During hospitalization, 1 month, 6 months, and 1 year postoperative.
Length of hospitalization
Length of hospital stay are measured from the anesthesia starting day to the discharge day
Time frame: till the day of discharge from hospital, an average of 7 days
Days at home up to 30 days after surgery (DAH30)
Time frame: up to 30 days after surgery
Economic indicators
Hospitalization fees; -Preoperative fees; -Anesthesia fees; -Surgery fees; -Post-operative fees; -Post-discharge medical expenses.
Time frame: during the entire trial, an average of 1 year.
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