Relationship Between Preoperative Frailty And Delirium In Elderly Patients After Colorectal Cancer Surgery

Objective: This study evaluated the preoperative frailty status of elderly patients undergoing colorectal cancer surgery,and studied the relationship between preoperative frailty and postoperative delirium。Methods: This study focused on elderly patients undergoing elective colorectal cancer surgery under general anesthesia.Inclusion criteria: 1)age ≥65 years old and < 90 years old,regardless of gender or ethnicity;2)expected operation time ≥ 2 hours;3)primary tumor,which has not undergone radiotherapy or chemotherapy before surgery;4)Agree to participate in this study and sign an informed consent form.Exclusion criteria: 1)Refusal to participate in this study;2)Past history of schizophrenia,epilepsy,Parkinson’s disease or myasthenia gravis;3)Due to severe dementia,language Obstacles,coma,end-stage disease and other conditions cannot complete the preoperative evaluation;4)critically ill(preoperative ASA grade ≥ IV);severe renal impairment(needed renal replacement therapy);severe liver damage(Child-Pugh grade C);5)Craniocerebral surgery;6)The attending doctor or investigator believes that there are other conditions that are not suitable for participating in this study,and any one of the above conditions will be excluded.All patients were treated with surgery under general anesthesia.Midazolam,sufentanil,rocuronium,and propofol were used for induction of anesthesia.Anesthesia was maintained by continuous inhalation of sevoflurane or intravenous propofol.Continuous infusion and continuous pumping of remifentanil to maintain analgesia,and intermittent bolus injections of cis-atracurium or rocuronium to maintain muscle relaxation.During the operation,other drugs can be used according to the relevant indicators of the patient’s hemodynamics,such as ephedrine,atropine,dopamine,norepinephrine and other drugs as appropriate to maintain stable circulation.Collect basic patient data,past history,anesthesia-related information,surgery-related information,intraoperative adverse events,fluid intake,blood loss,and urine output.Postoperative delirium,pain assessments are performed.At the same time,postoperative adverse reactions are recorded.Related complications,postoperative hospital stay,etc.In this study,the modified frailty index(m FI)scale was used to assess the frailty status of patients,which included 11 variables.According to whether the patients had delirium after operation,the patients were divided into delirium group(D group)and non-delirium group(N group).Data analysis used chi-square test,independent sample t-test,rank sum test and multivariate logistic regression to analyze the correlation between patients’ debilitating state and postoperative delirium.Results: A total of 370 patients were enrolled in this study.According to whether delirium occurred after operation,they were divided into delirium group and non-delirium group,40 cases(10.8%)in delirium group,330 cases(89.2%)in non-delirium group,multivariate logistic regression analysis Show:Age(OR 1.107,95% confidence interval 1.038～1.181,P<0.05),modified frailty index(OR 1.706,95% confidence interval 1.235～2.357,P<0.05)are independent risk factors for postoperative delirium.Conclusions: The modified frailty index can effectively predict the risk of postoperative delirium in elderly patients undergoing colorectal cancer surgery.Preoperative frailty is an independent risk factor for postoperative delirium...