Study On The Correlation Between Modified Frailty Index And Postoperative Delirium In Elderly Patients With Colorectal Cancer Surgery And Klotho Protein

Objective: To investigate the correlation between modified frailty index(m FI)and postoperative delirium and Klotho protein after laparoscopic colorectal cancer surgery in elderly patients.Methods: From September 2020 to February 2021 in the Affiliated Hospital of Yanbian University,the elderly patients who are scheduled to undergo elective laparoscopic colorectal cancer surgery were selected,regardless of gender,age ≥60years old,ASA grade Ⅱ-Ⅲ,operation time ≥2h,Body Mass Index(BMI)17-28kg/m2.Before surgery,the patients were evaluated with the modified frailty index.30 patients with m FI≥3 points were selected as the frailty group(group A,n=30),and 30 patients with m FI<3 points were selected as the non-frailty group(group B,n=30).The selected patients excluded those with abnormal mental and cognitive function before surgery.Both induction of anesthesia and intraoperative maintenance were given the same drugs.The jugular vein blood was respectively drawn before anesthesia and operation(T1)and after operation and anesthesia(T2).We recorded the following elements concerning the patient’s: m FI,Mini-mental state examination score one day before surgery,preoperative complications,preoperative hemoglobin,and albumin levels,operation method,operation and anesthesia time,anesthesia recovery time,intraoperative fluid infusion,intraoperative blood loss,urine volume,intraoperative blood transfusion.We used the revised Chinese version of the Confusion assessment method(CAM-CR)for postoperative follow-up.We recorded the CAM-CR score at 1,3,and 7 days postoperatively,the number and incidence of postoperative delirium(POD)in the two groups,and the levels of hemoglobin and albumin on the 1,3,and 5 days;The Klotho protein content in jugular venous blood at T1 and T2 time points was also measured with ELISA method.Results:(1)There was no statistically significant difference between group A and group B in gender,BMI,smoking history,drinking history,and operation method.The age of patients and the proportion of patients with high ASA grades in group A were higher than those in group B(P<0.05).(2)The incidence of diabetes history,preoperative functional status,chronic obstructive pulmonary disease,myocardial infarction,transient cerebral ischemia,and cerebrovascular accident in group A was higher than in group B(P<0.05).(3)The CAM-CR scores of patients in group A was higher than those in group B at 1,3,and 7 days after the operation(P<0.05).There were 8 cases and 2 cases of POD in the two groups within 7 days after operation.The incidence of POD in group A was higher than that in group B(P<0.05).(4)The operation time,anesthesia time,and recovery time of group A were higher than those of group B(P<0.01).However,there was no statistically significant difference in comparison of intraoperative fluid infusion,estimated blood loss,urine volume,and intraoperative blood transfusion.(5)The levels of hemoglobin and albumin in the two groups decreased on the 1,3,and 5 days after the operation.There were differences between the hemoglobin and albumin groups on the first and third days after the operation(P<0.05),and the values rose back to the average level on the 5th day after the operation.(6)Univariate analysis and multivariate logistic regression analysis showed that group A was more prone to POD than group B(OR: 8.953;95% CI: 1.518 ～ 52.798).(7)Compared with the preoperative value,the Klotho protein content of the two groups of patients after surgery was lower than that of preoperative(P<0.05),and the Klotho protein content of patients in group A decreased more significantly after surgery.The KLotho protein content of patients with POD was significantly lower than that before surgery(P<0.05),and the degree of reduction was more significant than that of patients without POD.Conclusion:(1)Debilitation evaluated by the modified index is a risk factor for delirium after laparoscopic colorectal cancer surgery in elderly patients.Debilitated patients are more likely to develop postoperative delirium than non-debilitated patients.(2)The Klotho protein content of debilitated and non-debilitated patients decreases after surgery,and debilitated patients are more pronounced;the occurrence of postoperative delirium may be related to the decrease of Klotho protein level.