A meta-analysis of risk factors of postoperative delirium of elderly hip fracture patients in China

doi:10.3969/j.issn.2095-4344.0251

Abstract

Abstract:

BACKGROUND: At present, there is no consensus on the risk factors for delirium after hip fracture in the elderly, and there is no risk prediction system that can effectively assess the risk of delirium after hip fracture in the elderly.

OBJECTIVE: To identify the risk factors of postoperative delirium of elderly hip fracture.

METHODS: Studies about delirium of elderly hip fracture patients were retrieved by computer. Quality of the studies was assessed. Analysis of sensitivity and heterogeneity was performed by RevMan 5.3 software and cumulative effects were calculated by either fixed or random effects models.

RESULTS AND CONCLOUSION: (1) Totally 15 studies included 872 cases of delirium and 3 221 cases of non-delirium. (2) The results of meta-analysis showed that: univariate analysis indicated that preoperative cognitive dysfunction [pooled OR=4.99, 95%CI(2.66, 9.37), P=0.000], age [pooled MD=3.60, 95%CI(2.21, 5.00), P=0.000], preoperative complications ≥ 3 [pooled OR=2.83, 95%CI(2.12, 3.79), P=0.000], preoperative hemoglobin < 100 mg/L [pooled OR=2.09, 95%CI(1.17, 3.76), P=0.01], preoperative albumin < 35 g/L [pooled OR=2.29, 95%CI(1.77, 2.97), P=0.01], general anesthesia [pooled OR=2.17, 95%CI(1.41, 3.34), P=0.000 4], the type or treatment of hip fracture [pooled OR=1.36, 95%CI(1.04, 1.78), P=0.02], operation time [pooled OR=2.88, 95%CI(1.42, 5.82), P=0.003], and intraoperative blood loss [pooled MD=36.97, 95%CI(25.74, 48.19), P=0.000] were the risk factors of postoperative delirium of elderly hip fracture patients. (3) Multivariate analysis showed that preoperative cognitive dysfunction [pooled=4.94, 95%CI(2.23, 10.95), P=0.000], age [pooled MD=2.84, 95%CI(1.89, 3.78), P=0.000], preoperative complications ≥ 3 [pooled OR=3.05, 95%CI(2.11, 4.41), P=0.000], general anesthesia [pooled OR=4.29, 95%CI(1.40, 13.14), P=0.01], and operation time ≥ 2.5 hours [pooled OR=2.62, 95%CI(1.68, 4.08), P=0.000] were independent risk factors for postoperative delirium of elderly hip fracture patients. (4) In conclusion, the independent risk factors of postoperative delirium of elderly hip fracture patients are preoperative cognitive dysfunction, age, preoperative complications ≥ 3, general anesthesia and operation time ≥ 2.5 hours. The type of fracture, preoperative waiting time, and type of operation are not related to postoperative delirium. However, due to the low quantity and quality of the included literature, the conclusion needs the support from many high-quality studies.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Hip Fractures, Delirium, Factor Analysis, Statistical, Meta-Analysis, Tissue Engineering

CLC Number:

R318

Lü Yang, Liu Qi-yu, Liu Jun, Chen Hai-yun, Pan Jian-ke, Li Xi-wen. A meta-analysis of risk factors of postoperative delirium of elderly hip fracture patients in China[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(15): 2437-2445.

Figures/Tables 7

2.2.2 年龄 7篇文献报道了年龄因素同术后谵妄的关系[7-8，10-11，13，16，18]，随机效应模型Meta分析结果显示，年龄是老年髋部骨折术后发生谵妄的危险因素[合并MD值=3.60，95%CI(2.21，5.00)，P=0.000]，见图4。多因素分析纳入4个研究[7，11，13，18]，固定效应模型Meta分析结果显示，年龄也是老年髋部骨折术后发生谵妄的独立危险因素[合并MD值=2.84，95%CI(1.89，3.78)，P=0.000]，见图5。 2.2.3 骨折类型老年髋部骨折类型为股骨颈骨折与股骨转子骨折，纳入文献中共有7篇文献报道了骨折类型同术后谵妄的关系[5-8，11，13-14]，将股骨颈骨折作为危险因素，纳入固定效应模型Meta分析结果显示，股骨颈骨折相对于股骨转子骨折对老年髋部骨折术后发生谵妄没有相关性[合并OR值=0.98，95%CI(0.79，1.21)，P=0.84]，见图6。 2.2.4 术前内科合并症≥3种 7篇文献报道了术前合并症同术后谵妄的关系[5-7，10，12，15，17]，固定效应模型Meta分析结果显示，术前内科合并症超过3种是老年髋部骨折术后发生谵妄的危险因素[合并OR 值=2.83，95%CI(2.12，3.79)，P=0.000]，见图7。多因素分析纳入4个研究[5-7，10]，固定效应模型Meta分析结果显示，术前内科合并症超过3种也是老年髋部骨折术后发生谵妄的独立危险因素[合并OR 值=3.05，95%CI(2.11，4.41)，P=0.000]，见图8。 2.2.5 术前血红蛋白<100 mg/L 6篇文献报道了术前血红蛋白同术后谵妄的关系[6-7，9，11，15，17]，固定效应模型Meta分析结果显示，术前血红蛋白<100 mg/L是老年髋部骨折术后发生谵妄的危险因素[合并OR值=2.09，95%CI(1.17，3.76)，P=0.01]，见图9。多因素分析纳入1个研究[13]。 2.2.6 术前白蛋白<35 g/L 5篇文献报道了术前白蛋白同术后谵妄的关系[5-7，11，15]，固定效应模型Meta分析结果显示，术前白蛋白<35 g/L是老年髋部骨折术后发生谵妄的危险因素[合并OR值=2.29，95%CI(1.77，2.97)，P=0.01]，见图10。多因素分析纳入1个研究[6]。 2.2.7 术前等待时间 5篇文献报道了术前等待时间同术后谵妄的关系[6-8，12，16]，随机效应模型Meta分析结果显示，术前等待间长短与老年髋部骨折术后发生谵妄无相关性[合并MD值=0.59，95%CI(-0.16，1.34)，P=0.13]，见图11。多因素分析纳入1个研究[8]。"

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