Predictors of Postoperative Delirium in Non-Intensive Care Unit Elderly Spinal Surgery Patients: The Impact of Diabetes and Early Postoperative Pain

OBJECTIVE: To explore the risk factors for postoperative delirium (POD) in elderly patients after spinal surgery. METHODS: The clinical data of 1035 elderly patients (aged ≥65 years) who underwent spinal surgery were analyzed from January 2018 to December 2022 at the Department of Spinal Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei. This study focused on patients at the ward level (non-intensive care unit patients). POD was assessed using the confusion assessment method. Patients were divided into 2 groups on the basis of whether POD occurred: the POD group (group A) and the non-POD group (group B). The variables included patient characteristics, baseline symptoms, and operation-related factors. Risk factors were identified using univariate and multivariate logistic regression analyses. RESULTS: POD occurred in 116 of the 1035 patients included in the study, with an incidence rate of 11%. Univariate analysis revealed significant differences in age, emergency surgery, waiting days from admission to surgery (more than 3 days), diabetes status, preoperative cognitive dysfunction, operation time, intraoperative hypotension (systolic blood pressure [SBP] < 80 mmHg), and post-anesthesia care unit-visual assessment score (PACU-VAS) score between group A and group B (P < 0.05). Multivariate logistic regression analysis revealed that age (odds ratio [OR = 1.133, 95% confidence interval [CI]: 1.109-1.267, P = 0.017), emergency surgery (OR = 2.527, 95% CI: 1.207-5.624, P = 0.012), diabetes (OR = 1.532, 95% CI: 1.012-2.321, P = 0.043), preoperative cognitive dysfunction (OR = 3.239, 95% CI: 1.529-9.092, P = 0.018), operation time (OR = 1.019, 95% CI: 1.008-1.027, P = 0.002), intraoperative hypotension (SBP < 80 mmHg; OR = 2.105, 95% CI: 1.141-2.342, P = 0.014), and PACU-VAS (OR = 1.907, 95% CI: 1.265-2.334, P = 0.021) were positively correlated with POD in elderly patients after spinal surgery. While the factor "waiting days from admission to surgery (more than 3 days)" was associated with POD in the univariate analysis, it was not retained as an independent risk factor in the final multivariate model. CONCLUSIONS: Advanced age, emergency surgery, diabetes, preoperative cognitive dysfunction, long operation time, intraoperative hypotension (SBP