The POD prediction model using age, diazepam use history, cerebrovascular disease history, and intraoperative fluid balance showed good discrimination with an AUC of 0.703 and identified risk for 10.9% POD incidence after elective abdominal surgery.
Observational (n=838)
No
A 4-factor prediction model incorporating age, diazepam use history, cerebrovascular disease history, and intraoperative fluid balance can moderately predict postoperative delirium in patients undergoing abdominal surgery.
Effect estimate: AUC 0.703 (95% CI 0.637-0.753) in training set; cross-validation mean AUC 0.684 (SD 0.068); external validation AUC 0.634 (95% CI 0.511-0.758) (95% CI 95% CI 0.637-0.753, 95% CI 0.511-0.758)
Abstract Background Postoperative delirium (POD) is a common complication following major surgery in elderly. The purpose of this study was to develop and evaluate a POD prediction model for patients undergoing abdominal surgery. Methods One thousand consecutive patients scheduled for elective abdominal surgery from July 2019 to March 2021 in Ruijin Hospital, Shanghai China, were retrospectively analysed, and their demographics, pre-operative evaluation, and intra-operative parameters were collected and cross-analysed. The primary outcome was the POD incidence. A prediction model of POD was established and internal validation was conducted with various analyses including univariate and multivariate regression. Data from another cohort of346 patients enrolled from July 2021 to December 2021 were used for model external validation. Results After screening, 838 patients were included as the training cohort and 10.9% (91/838) of the patients manifested POD. Old age, cerebrovascular disease and diazepam use history and intraoperative fluid imbalance were the main contributors of the POD prediction model. The optimum cut-off point of the predicted probability that maximised the sum of sensitivity and specificity was 0.12. The fitting set AUC was 0.703 (95% Confidence interval (CI) 0.637–0.753). The sensitivity and specificity of the model were 0.556 and 0.754 respectively. The mean AUC during the cross and external validation of the model was 0.684 Standard Deviation (SD) 0.068 and 0.634 (95%CI 0.511–0.758) respectively. Conclusions Our data indicated that improving perioperative management may reduce POD incidence in patients who are old age and have cerebrovascular disease history. Trial registration The retrospective data (ChiCTR2100047405) of this study was registered in the Chinese Clinical Trial registry ( https://www.chictr.org.cn/ ).
Huang et al. (Sat,) conducted a observational in Adults (18-86 years) undergoing elective abdominal surgery (n=838). POD prediction model using age, diazepam use history, cerebrovascular disease history and intraoperative fluid balance vs. No risk prediction model (usual care) was evaluated on Incidence of postoperative delirium (POD) diagnosed by Confusion Assessment Method within 7 days post-surgery (AUC 0.703 (95% CI 0.637-0.753) in training set; cross-validation mean AUC 0.684 (SD 0.068); external validation AUC 0.634 (95% CI 0.511-0.758), 95% CI 95% CI 0.637-0.753, 95% CI 0.511-0.758). The POD prediction model using age, diazepam use history, cerebrovascular disease history, and intraoperative fluid balance showed good discrimination with an AUC of 0.703 and identified risk for 10.9% POD incidence after elective abdominal surgery.