Risk factors for postoperative delirium in geriatric patients with hip fracture: A systematic review and meta-analysis

Yi-Ming Qi, Ying-Juan Li, Ji-Hong Zou, Xiao-Dong Qiu, Jie Sun, Yun-Feng Rui, Yi-Ming Qi, Ying-Juan Li, Ji-Hong Zou, Xiao-Dong Qiu, Jie Sun, Yun-Feng Rui

Abstract

Objectives: This systematic review and meta-analysis was conducted to identify the potential risk factors for postoperative delirium in geriatric patients with hip fracture.

Methods: PubMed, EMBASE, and Cochrane Library were searched from inception until December 31st, 2021. A combined searching strategy of subject words and free words was adopted. Studies involving risk factors for postoperative delirium in elderly patients undergoing hip fracture surgeries were reviewed. Qualities of included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled and a meta-analysis was performed using Review Manager 5.3.

Results: A total of 37 studies were included. The following risk factors were significant: advanced age (per year increase) (OR: 1.05, 95% CI 1.04-1.07), age>80 years (OR: 2.26, 95% CI 1.47-3.47), male (OR: 1.53, 95% CI 1.37-1.70), preoperative cognitive impairment (OR:3.20, 95% CI 2.12-4.83), preoperative dementia (OR: 2.74, 95% CI 2.18-3.45), preoperative delirium (OR: 9.23, 95% CI 8.26-10.32), diabetes (OR: 1.18, 95% CI 1.05-1.33), preoperative functional dependence (OR: 1.31, 95% CI 1.11-1.56), ASA level (per level increase) (OR: 1.63, 95% CI 1.04-2.57), ASA level≥3(OR: 1.76, 95% CI 1.39-2.24), low albumin (OR: 3.30, 95% CI 1.44-7.55), medical comorbidities (OR: 1.15, 95% CI 1.06-1.25), Parkinson's disease (OR: 4.17, 95% CI 1.68-10.31) and surgery delay>48 h (OR: 1.90, 95% CI 1.36-2.65).

Conclusions: Clinicians should be alert to patients with those risk factors. To identify the risk factors more precisely, more research studies with larger sample size and better design should be conducted.

Keywords: geriatric; hip fracture; meta-analysis; postoperative delirium; risk factors; systematic review.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Qi, Li, Zou, Qiu, Sun and Rui.

Figures

Figure 1
Figure 1
The flow diagram of the search process of the literature and the result of the literature search.
Figure 2
Figure 2
Forest plot for age (per year increase).
Figure 3
Figure 3
Funnel plot for age (per year increase) for the investigation of publication bias.
Figure 4
Figure 4
Forest plot for age>80 years.
Figure 5
Figure 5
Forest plot for male.
Figure 6
Figure 6
Forest plot for preoperative cognitive impairment.
Figure 7
Figure 7
Forest plot for preoperative dementia.
Figure 8
Figure 8
Forest plot for preoperative delirium.

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