Relationship between physical activity and postoperative delirium in elderly patients undergoing knee or hip arthroplasty
10.3760/cma.j.cn131073.20240118.00804
- VernacularTitle:体力活动与膝或髋关节置换术老年患者术后谵妄的关系
- Author:
Jian KONG
1
;
Yunfei QIU
;
Shanling XU
;
Yuanlong WANG
;
Shuhui HUA
;
Yanan LIN
;
Chuan LI
;
Rui DONG
;
Hongyan GONG
;
Xu LIN
;
Bin WANG
;
Yanlin BI
Author Information
1. 山东第二医科大学麻醉学院，潍坊 261053
- Keywords:
Physical exertion;
Arthroplasty, replacement, knee;
Arthroplasty, replacement, hip;
Postoperative complications;
Aged;
Delirious speech
- From:
Chinese Journal of Anesthesiology
2024;44(8):922-926
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the relationship between physical activity (PA) and postoperative delirium (POD) in elderly patients undergoing knee or hip arthroplasty.Methods:The study was conducted as part of the Perioperative Neurocognitive Impairment and Biomarkers Lifestyle Cohort, which was a nested case-control study. Medical records from elderly patients undergoing elective knee or hip arthroplasty under spinal-epidural anesthesia at Qingdao Municipal Hospital from August 2022 to August 2023 were collected. The patients were divided into a POD group ( n=89) and a non-POD group ( n=221) based on the occurrence of POD. Peripheral blood samples were collected before surgery, and the cerebrospinal fluid (CSF) 2 ml was extracted after successful puncture under spinal-epidural anesthesia for determination of the concentrations of amyloid-β 42 (Aβ 42), total tau protein (t-tau), and phosphorylated tau protein (p-tau) by enzyme-linked immunosorbent assay. Logistic regression was used to analyze the influencing factors of POD, and the mediation analysis was conducted to examine the mediating role of CSF biomarker in the relationship between PA and POD. Results:Logistic regression analysis showed that the increased concentration of CSF biomarkers Aβ 42 ( OR=0.997, P=0.006), elevated ratio of Aβ 42/t-tau ( OR=0.642, P=0.003), elevated ratio of Aβ 42/p-tau ratio ( OR=0.872, P=0.001) and PA ( OR=0.374, P=0.001) were protective factors for POD, while the elevated concentrations of t-tau ( OR=1.006, P=0.001) and p-tau ( OR=1.030, P=0.011) were risk factors for POD after adjusting for multi-confounders such as hypertension, diabetes, history of drinking, years of education and Mini-Mental State Examination score. The results of the mediation analysis showed that Aβ 42 (20%), t-tau (16%), Aβ 42/t-tau (23%) and Aβ 42/p-tau (28%) played mediating roles in the relationship between PA and POD. Conclusions:PA is a protective factor for POD in elderly patients undergoing knee or hip arthroplasty and CSF biomarkers may play a mediating role in the relationship between PA and POD.
