Related Factors For Postoperative Delirium After Orthopedic Surgery-A Meta Analysis

BackgroundPostoperative Delirium(POD),Is a syndrome with high morbidity and mortality in elderly hospitalized patients with cognitive dysfunction and symptoms related to acute mental pathological.With the development of surgical techniques,more and more diseases can be cured with surgery,Also present a growth trend in patients undergoing surgery,so the number of patients complicated with postoperative delirium also gradually increase,Furthermore the aging of the population increase,more older patients received operation again increased the risk of patients suffering from delirium,thus postoperative delirium has been interdisciplinary scholar's attention.Previous studies of delirium have focused on anesthesiology,ICU,and psychiatry,orthopedic patients complicated with postoperative delirium are mainly concentrated in trauma patients,so the orthopedic postoperative delirium related research is mainly concentrated in the patients with hip fracture.Due to the aging of the population in recent years makes the degenerative diseases such as knee osteoarthritis,cervical spondylosis,lumbar disc disease increased,while a growing number of elderly patients for higher life quality requirements,led to the number of knee replacement surgery?the lumbar spinal fusion surgery increased,so as to make the spine and joint surgery patients complicated with postoperative delirium.Orthopedic perioperative factors cause delirium has been relevant researchers study adequately,But for the correlation of perioperative factors caused delirium,researchers have the same or different or even contrary conclusions.ObjectiveThis study aimed to examine the Orthopedic perioperative factors of Postoperative Delirium in Orthopedics by meta-analysis.MethodsSuch databases as PubMed(~ 2017.1)?Elsevier Science Direct(~ 2017.1)?Springer(~ 2017.1)? Cochrane Library(~ 2017.1)were electronically and comprehensively searched for relevant studies on risk factor for postoperative delirium.Literature screening according to the inclusion and exclusion criteria,data extraction and methodological quality assessment were completed by two reviewers independently.Meta-analysis was then conducted using STATA 11.0.ResultAfter screening,we included 19 articles,a total of 4218 cases of the research object,with 723 cases patients with delirium,17.14% incidence of delirium.In orthopedic surgery:(1)the average age of patients [WMD = 3.30,p = 3.30,95% CI(0.587,0.587),hypertension(RR = 1.165,p = 0.043,95% CI(1.005,1.351)],congestive heart failure(RR = 1.558,p = 0.002,95% CI(1.169,2.076)] was significantly associated with delirium;patients complicated with delirium has a clear correlation with the length of hospital stay [WMD = 1.673,P = 1.673,95% CI(0.895,2.450)].Diabetes(RR = 1.759,Z = 1.759,p = 0.004,95% CI(1.199,2.581)],preoperative cognitive dysfunction [RR = 1.976,p = 0.000,95% CI(1.757,2.224)],and was significantly associated with delirium.But the heterogeneity is too large[Diabetes researches(I2=81.40%),preoperative cognitive dysfunction(I2=87.40%)],the results should be cautious.In hip fracture surgery[RR = 1.048,P = 1.048,95% CI(0.903,0.903)],spine surgery [RR = 1.120,P = 0.481,95% CI(0.818,0.818)],joint replacement surgery[RR = 0.721,P = 0.249,95%(0.414,1.258)],gender was not significantly associated with delirium.History of coronary heart disease(RR = 1.405,P = 0.086,95% CI(0.953,2.074)],general anesthesia surgery [RR = 0.992,P = 0.992,95% CI(0.882,1.115)],intraoperative blood loss [WMD = 1.516,P = 0.978,95% CI(109.735,109.735)],intraoperative fluid intake [WMD = 136.928,P = 136.928,95%CI(245.903,519.758)] was not significantly associated with delirium.(2)In spinal surgery patients: operation time[(P = 0.008,95% CI(6.779,46.336)]had obvious correlation with the incidence of delirium,blood transfusion[Z=0.33,P=0.744,95%CI(0.631,1.907)] was not significantly associated with delirium.(3)In Chinese research: BMI [Z = 0.13,P = 0.13,95% CI(0.596,0.683)] was not significantly associated with delirium.Conclusion(1)In orthopaedic patients,age was significantly associated with delirium,Elderly patients were more likely to Suffer from delirium;high blood pressure,complicated with congestive heart failure may increase the chances of patients suffering from delirium;patients' gender,history of coronary heart disease,the choice of anesthesia,intraoperative fluid intake,intraoperative blood loss were not significantly associated with delirium;patients complicated with delirium can increase the length of hospital stay.(2)in spinal surgery:it has a greater chance to suffer from delirium with a longer duration of operation;There was no significant correlation between blood transfusion and delirium.(3)In Chinese study: there was no significant correlation between BMI and postoperative delirium.