Risk Factors Of Postoperative Delirium In Intensive Care Patients:A Systematic Review And Meta-analysis

Objectives:This study aims to synthesize the risk factors of postoperative delirum in critically ill patients.Methods:Eight databases including CNKI,Wanfang,VIP Chinese Journal Service Platform,Chinese Biomedical Document Service System,Pubmed、Cochrane Central Register.Embase(OVID)、CINAHL(EBSCO)were searched from the establishment of the database to October 21,2020.Studies focused on risk factors of postoperative delirium in intensive care patients were included.Two people independently screened the literature,extracted data according to the inclusion and exclusion criteria.Newcastle-Ottawa Scale(NOS)and the Agency for Healthcare Research and Quality(AHRQ)were used to evaluate the quality of included studies.R software was used for synthesizing quantitative data.Results:A total of 25 studies were included,including 18 cohort studies,5 case-control studies,and 2 cross-sectional studies.The total number of cases in the study was 10388,the total incidence of delirium was 18%,and a total of 84 risk factors were included.Meta-analysis showed that age(OR=1.08,95%CI:1.03～1.14),hypertension(OR=2.95,95%CI:1.93～4.51),diabetes mellitus(OR=3.30,95%CI:2.01～5.41),history of cognitive impairment(OR=6.51,95%CI:1.60～26.44),duration of mechanical ventilation(OR=1.90,95%CI:1.22～1.29),APACH Ⅱ score(OR=1.90,95%CI:1.22～1.29),poor postoperative sleep quality(OR=4.32,95%CI:2.41～7.77),postoperative use of midazolam(OR=2.36,95%CI:1.47～3.80),malnutrition(OR=2.05,95%CI:1.41～2.98),combined with hypoxemia(OR=2.33,95%CI:1.35～4.04)and electrolyte disturbances(OR=2.54,95%CI:1.34～4.28)were independent risk factors for critically ill patients with postoperative delirium.Conclusions:There are 11 risk factors(age,hypertension,diabetes mellitus,history of cognitive impairment,duration of mechanical ventilation,APACHE Ⅱ score,poor sleep quality,midazolam use,malnutrition,hypoxemia,and electrolytes disorders)are associated with the occurrence of postoperative delirium in critically ill patients,Surgery duration was not associated with the occurrence of postoperative delirium in critically ill patients.