surgery and (2) intraoperative frontal alpha power is a mediator of the association between preoperative diabetes and POD. METHODS: This was a prospective matched cohort study of patients aged 60 years or more, with a preoperative diabetes who underwent elective orthopedic surgery. Nondiabetic patients were matched 1:1 to diabetic patients in terms of age, sex, and type of surgery. Primary outcome was occurrence of POD, assessed using the 3-minute Diagnostic Confusion Assessment Method (3D-CAM) once daily from 6 pm to 8 pm during the postoperative days 1–7 or until discharge. Secondary outcome was the severity of POD which was assessed for all participants using the short form of the CAM-Severity. Frontal electroencephalogram (EEG) was recorded starting before induction of anesthesia and lasting until discharge from the operating room. Intraoperative alpha power was calculated using multitaper spectral analyses. Mediation analysis was used to estimate the proportion of the association between preoperative diabetes and POD that could be explained by intraoperative alpha power. RESULTS: A total of 138 pairs of eligible patients successfully matched 1:1. After enrollment, 6 patients in the diabetes group and 4 patients in the nondiabetes group were excluded due to unavailability of raw EEG data. The final analysis included 132 participants with preoperative diabetes and 134 participants without preoperative diabetes, with a median age of 68 years and 72.6% of patients were female. The incidence of POD was 16.7% (22/132) in patients with preoperative diabetes vs 6.0% (8/134) in patients without preoperative diabetes. Preoperative diabetes was associated with increased odds of POD after adjustment of age, sex, body mass index, education level, hypertension, arrhythmia, coronary heart disease, and history of stroke (odds ratio, 3.2; 95% confidence interval [CI], 1.4–8.0; P = .009). The intraoperative alpha power accounted for an estimated 20% (95% CI, 2.6–60%; P = .021) of the association between diabetes and POD. CONCLUSIONS: This study suggests that preoperative diabetes is associated with an increased risk of POD in older patients undergoing major orthopedic surgery, and that low intraoperative alpha power partially mediates such association....

中文翻译：

---

接受大型骨科手术的老年患者术前糖尿病与术后谵妄的关联：一项前瞻性匹配队列研究

(2) 术中额叶 α 功率是术前糖尿病和 POD 之间关联的中介因素。方法：这是一项前瞻性配对队列研究，对象为 60 岁或以上、术前患有糖尿病并接受择期骨科手术的患者。非糖尿病患者与糖尿病患者在年龄、性别和手术类型方面进行 1:1 匹配。主要结局是 POD 的发生，在术后第 1-7 天或直至出院期间，每天下午 6 点至晚上 8 点使用 3 分钟诊断混乱评估方法 (3D-CAM) 进行评估。次要结果是 POD 的严重程度，使用 CAM-Sever 的缩写形式对所有参与者进行评估。从麻醉诱导前开始记录额叶脑电图（EEG），一直持续到从手术室出院。使用多锥光谱分析计算术中α功率。中介分析用于估计术前糖尿病与 POD 之间的关联比例，该关联可以通过术中 α 功率来解释。结果：共有138对符合条件的患者1:1成功匹配。入组后，由于无法获得原始脑电图数据，糖尿病组的 6 名患者和非糖尿病组的 4 名患者被排除。最终分析包括132名术前患有糖尿病的参与者和134名术前没有糖尿病的参与者，中位年龄为68岁，其中72.6%的患者为女性。术前患有糖尿病的患者 POD 发生率为 16.7% (22/132)，而术前无糖尿病的患者则为 6.0% (8/134)。调整年龄、性别、体重指数、教育水平、高血压、心律失常、冠心病和中风病史后，术前糖尿病与 POD 几率增加相关（比值比，3.2；95% 置信区间 [CI]，1.4） –8.0；P = .009)。术中 α 功率估计占糖尿病与 POD 之间关联的 20%（95% CI，2.6-60%；P = .021）。结论：这项研究表明，术前糖尿病与接受大型骨科手术的老年患者 POD 风险增加相关，并且术中低 α 功率部分介导了这种关联。