임상간호연구 (Journal of Korean Clinical Nursing Research)

  • 제28권2호
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  • Pages.137-145
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  • 2022
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  • 1598-9186(pISSN)
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  • 2287-3694(eISSN)
병원간호사회 (Hospital Nurses Association)
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외과계 병동 노인 수술 환자의 섬망 발생률과 위험요인

The Incidence and risk factors of delirium in elderly surgical patients

  • Lee, Eun Ju (Department of Nursing, Seoul National University Hospital) ;
  • Jang, Mi (Department of Nursing, Seoul National University Hospital) ;
  • Kim, Myung Hwa (Department of Nursing, Seoul National University Hospital) ;
  • Yun, Hye Jun (Department of Nursing, Seoul National University Hospital) ;
  • Kim, Eun Mi (Department of Nursing, Seoul National University Hospital) ;
  • Chung, Young In (Department of Nursing, Seoul National University Hospital) ;
  • Kim, Bo Kyung (Department of Nursing, Seoul National University Hospital) ;
  • Im, Eun Su (Department of Nursing, Seoul National University Hospital) ;
  • Hong, Kyoung Soon (Department of Nursing, Seoul National University Hospital)
  • 투고 : 2022.02.15
  • 심사 : 2022.06.24
  • 발행 : 2022.08.31
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초록

Purpose: This retrospective chart review study was conducted to examine the frequency of delirium and to identify the risk factors of delirium in elderly surgical patients. Methods: The subjects of this study were 394 patients aged 65 years or older who underwent surgery. The diagnosis of delirium was based on the nursing assessment records with scores from the day of surgery to the 4th day after surgery. The collected data were analyzed by binary logistic regression analysis. Results: The incidence of delirium was 4.3%, and delirium occurred most frequently on the first day of surgery and lasted for 2.16 days on average. Of delirium patients, 76.5% underwent gastrointestinal surgery, and the most common delirium pattern was disorientation. In terms of the characteristics of the subjects, the occurrence of delirium was statistically different by age (𝝌2=10.79, p=.005), systemic-specific disease (𝝌2=9.63, p=.047), use of delirium-inducing drug(benzodiazepine) before surgery (𝝌2=15.90, p<.001), walking ability before surgery (𝝌2=7.65, p=.006), history of delirium (𝝌2=35.92, p<.001), and emergency surgery (𝝌2=16.40, p<.001). As risk factors of delirium, gastrointestinal surgery was found to increase the risk of delirium by 12.57 times (95% CI=2.45~64.46, p=.002), and the use of benzodiazepines before surgery was shown to increase delirium by 10.07 times (95% CI=2.21~45.87, p=.003). Conclusion: It is necessary for nurses to actively evaluate delirium using screening tools for early detection and prevention of delirium in elderly surgical patients with delirium risk factors.

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참고문헌

  1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911-922. https://doi.org/10.1016/S0140-6736(13)60688-1
  2. Saxena S, Lawley D. Delirium in the elderly: A clinical review. Postgraduate Medical Journal. 2009;85(1006):405-413. https://doi.org/10.1136/pgmj.2008.072025
  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders DSM-IV-TR. 4th ed. text revision. Washington (DC): American Psychiatric Association; 2000. p. 943.
  4. Chaput AJ, Bryson GL. Postoperative delirium: Risk factors and management: Continuing professional development. Canadian Journal of Anaesthesia. 2012;59(3):304-320. https://doi.org/10.1007/s12630-011-9658-4
  5. Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: A meta-analysis. Journal of the American Medical Association. 2010;304(4):443-451. https://doi.org/10.1001/jama.2010.1013
  6. Bohner H, Hummel TC, Habel U, Miller C, Reinbott S, Yang Q, et al. Predicting delirium after vascular surgery: A model based on pre and intraoperative data. Annals of Surgery. 2003;238(1):149-156. https://doi.org/10.1097/01.sla.0000077920.38307.5f
  7. Ansaloni L, Catena F, Chattat R, Fortuna D, Franceschi C, Mascitti P, et al. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. British Journal of Surgery. 2010;97(2):273-280. https://doi.org/10.1002/bjs.6843
  8. Chung MH, Yun, SO, Park JH, Chu SO, Oh SY, Kim MY. Predictors of delirium in patients after orthopedic surgery. Journal of Korean Clinical Nursing Research. 2011;17(3):443-454. https://doi.org/10.22650/JKCNR.2011.17.3.14
  9. Noimark D. Predicting the onset of delirium in the post-operative patient. Age and Ageing. 2009;38(4):368-373. https://doi.org/10.1093/ageing/afp024
  10. Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M. Postoperative delirium in the elderly: Risk factors and outcomes. Annals of Surgery. 2009;249(1):173-178. https://doi.org/10.1097/SLA.0b013e31818e4776
  11. Statistics Korea. 2019 Major Surgery Statistics: Status by Order/Gender [Internet]. Daejeon: Statistics Korea; 2021 [cited 2021 Feb 15]. Available from: https://kosis.kr/statHtml/statHtml.do?orgId=350&tblId=TX_35004_A000&conn_path=I2.
  12. Kim MS, Jun JY, Chun HJ, Kim YO. The incidence and related risk factors of delirium in the older inpatients with neurological disorders in a tertiary hospital. Korean Journal of Adult Nursing. 2018;30(3):255-265. https://doi.org/10.7475/kjan.2018.30.3.255
  13. Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA. Fast, systematic, and continuous delirium assessment in hospitalized patients: The nursing delirium screening scale. Journal of Pain and Symptom Management. 2005;29(4):368-375. https://doi.org/10.1016/j.jpainsymman.2004.07.009
  14. Kim KN, Kim CH, Kim KI, Yoo HJ, Park SY, Park YH. Development and validation of the Korean Nursing Delirium Scale. Journal of Korean Academy of Nursing. 2012;42(3):414-423. https://doi.org/10.4040/jkan.2012.42.3.414
  15. Park SY. Risk factors of delirium in older inpatients after abdominal surgery [master's thesis]. Seoul: Hanyang University; 2021. p. 1-50.
  16. Lee YW, Im HB, Jeong EJ, Ma HS. Influencing factors of the incidence of delirium in elderly patients with arthroplasty. Korean Journal of Adult Nursing. 2012;24(4):348-357. https://doi.org/10.7475/kjan.2012.24.4.348
  17. Litaker D, Locala J, Franco K, Bronson DL, Tannous Z. Preoperative risk factors for postoperative delirium. General Hospital Psychiatry. 2001;23(2):84-89. https://doi.org/10.1016/S0163-8343(01)00117-7
  18. Kim KH, Kho DH, Shin JY, Choi JY, Kim ES, Kim DH. Risk factors of postoperative delirium in elderly patients with hip fractures. Journal of the Korean Fracture Society. 2008;21(3):189-194. https://doi.org/10.12671/jkfs.2008.21.3.189
  19. Sasajima Y, Sasajima T, Azuma N, Akazawa K, Saito Y, Inaba M, et al. Factors related to postoperative delirium in patients with lower limb ischaemia: A prospective cohort study. European Journal of Vascular and Endovascular Surgery. 2012;44(4):411-415. https://doi.org/10.1016/j.ejvs.2012.06.028
  20. Choi SJ, Cho YA. Prevalence and related risk factors of delirium in intensive care units as detected by the CAM-ICU. Journal of Korean Clinical Nursing Research. 2014;20(3):406-416. https://doi.org/10.22650/JKCNR.2014.20.3.406
  21. Cerejeira J, Nogueira V, Luis P, Vaz-Serra A, Mukaetova-Ladinska EB. The cholinergic system and inflammation: Common pathways in delirium pathophysiology. Journal of the American Geriatrics Society. 2012;60(4):669-675. https://doi.org/10.1111/j.1532-5415.2011.03883.x
  22. Brouquet A, Cudennec T, Benoist S, Moulias S, Beauchet A, Penna C, et al. Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Annals of Surgery. 2010;251(4):759-765. https://doi.org/10.1097/SLA.0b013e3181c1cfc9
  23. Kim MY. Development and validation of a delirium prediction scoring system for major surgery patients [dissertation]. Daegu: Keimyung University; 2015. p. 1-100.
  24. de Castro SM, Unlu C, Tuynman JB, Honig A, van Wagensveld BA, Steller EP, et al. Incidence and risk factors of delirium in the elderly general surgical patient. American Journal of Surgery. 2014;208(1):26-32. https://doi.org/10.1016/j.amjsurg.2013.12.029