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. 2023 Jul 21:19:1641-1654.
doi: 10.2147/NDT.S416854. eCollection 2023.

Development and Validation of a Delirium Risk Prediction Model for Elderly Patients Undergoing Elective Orthopedic Surgery

Yaxin Guo  1 , Haiyan Ji  1 , Junfeng Liu  1 , Yong Wang  1 , Jinming Liu  1 , Hong Sun  1 , Yuanhui Fei  1 , Chunhui Wang  1 , Tieliang Ma  2 , Chao Han  1   3
Affiliations

Development and Validation of a Delirium Risk Prediction Model for Elderly Patients Undergoing Elective Orthopedic Surgery

Yaxin Guo et al. Neuropsychiatr Dis Treat. .

Abstract

Purpose: This study aimed to develop and validate a post-operative delirium (POD) nomogram in a population of elderly patients undergoing elective orthopedic surgery.

Patients and methods: A predictive model was developed based on a training dataset of 474 elderly patients undergoing elective orthopedic surgery from March 2021 to May 2022. POD was identified using the Confusion Assessment Methods (CAM). The least absolute shrinkage and selection operator (LASSO) method was used to screen risk factors, and prediction models were created by combining the outcomes with logistic regression analysis. We employ bootstrap validation for internal validation to examine the model's repeatability. The results were validated using a prospective study on 153 patients operated on from January 2022 to May 2022 at another institution.

Results: The predictors in the POD nomogram included age, the Mini-Mental State Examination(MMSE), sleep disorder, neurological disorders, preoperative serum creatinine (Pre-SCR), and ASA classification. The c-index of the model was 0.928 (95% confidence interval 0.898 ~ 0.957) and the bootstrap validation still achieved a high c-index of 0.912. The c-index of the external validation was 0.921. The calibration curve for the diagnostic probability showed good agreement between prediction by nomogram and actual observation.

Conclusion: By combining preoperative and intraoperative clinical risk factors, we created a POD risk nomogram to predict the probability of POD in elderly patients who undergo elective orthopedic surgery. It could be a tool for guiding individualized interventions.

Keywords: elderly; elective orthopedic surgery; nomogram; post-operative delirium; predictive models.

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Conflict of interest statement

Dr Chao Han reports grants from Health Commission of Wuxi, grants from Wuxi Association for Science and Technology, grants from Health Commission of Jiangsu, during the conduct of the study. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow Chart.
Figure 2
Figure 2
Selection of risk factors for POD using the LASSO binary logistic regression model.
Figure 3
Figure 3
Developed POD nomogram.
Figure 4
Figure 4
Calibration curves and decision curve analysis for the POD nomogram.
See this image and copyright information in PMC

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References

    1. de la Varga-Martínez O, Gómez-Pesquera E, Muñoz-Moreno MF, et al. Development and validation of a delirium risk prediction preoperative model for cardiac surgery patients (DELIPRECAS): an observational multicentre study. J Clin Anesth. 2021;69:110158. doi:10.1016/j.jclinane.2020.110158 - DOI - PubMed
    1. Bruce AJ, Ritchie CW, Blizard R, Lai R, Raven P. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr. 2007;19(2):197–214. - PubMed
    1. Mosk CA, Mus M, Vroemen JP, et al. Dementia and delirium, the outcomes in elderly Hip fracture patients. Clin Interv Aging. 2017;12:421–430. - PMC - PubMed
    1. Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth. 2020;125(4):492–504. - PubMed
    1. Glumac S, Kardum G, Karanovic N. Postoperative Cognitive Decline After Cardiac Surgery: a Narrative Review of Current Knowledge in 2019. Med Sci Monit. 2019;25:3262–3270. - PMC - PubMed