Predictors of postoperative delirium in elderly patients following total hip and knee arthroplasty: a systematic review and meta-analysis

Quan Zhou, Xinfeng Zhou, Yijian Zhang, Mingzhuang Hou, Xin Tian, Huilin Yang, Fan He, Xi Chen, Tao Liu, Quan Zhou, Xinfeng Zhou, Yijian Zhang, Mingzhuang Hou, Xin Tian, Huilin Yang, Fan He, Xi Chen, Tao Liu

Abstract

Background: Postoperative delirium (POD) is widely reported as a common postoperative complication following total joint arthroplasty (TJA) of the hip and knee in elderly patients, leading to many adverse effects. We sought to investigate predictors of delirium after TJA.

Methods: PubMed, EMBASE, Cochrane Library and Web of Science were searched up to 2020 for studies examining POD following TJA in elderly patients. Pooled odds ratio (OR) and mean difference (MD) of those who experienced delirium compared to those who did not were calculated for each variable. The Newcastle-Ottawa Scale (NOS) was used for the study quality evaluation.

Results: Fifteen studies with 31 potential factors were included. In the primary analysis, 9 factors were associated with POD, comprising advanced age (MD 3.81; 95% confidence interval (CI) 1.80-5.83), dementia (OR 24.85; 95% CI 7.26-85.02), hypertension (OR 2.26; 95% CI 1.31-3.89), diabetes (OR 2.02; 95% CI 1.15-3.55), stroke (OR 14.61; 95% CI 5.26-40.55), psychiatric illness (OR 2.72; 95% CI 1.45-5.08), use of sedative-hypnotics (OR 6.42; 95% CI 2.53-16.27), lower preoperative levels of hemoglobin (MD - 0.56; 95% CI - 0.89-- 0.22), and lower preoperative mini-mental state examination score (MD - 0.40; 95% CI - 0.69-- 0.12). Twelve studies were included in the systematic review, of which 24 factors were additionally correlated with POD using single studies.

Conclusions: Strategies and interventions should be implemented for the elderly patients receiving TJA surgeries with potential predictors identified in this meta-analysis.

Keywords: Postoperative delirium; Predictors; Total hip arthroplasty; Total joint arthroplasty; Total knee arthroplasty.

Conflict of interest statement

All authors declare that they have no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
PRISMA flowchart describing the study’s systematic literature search and study selection
Fig. 2
Fig. 2
Forest plot of advanced age between Delirium and No Delirium groups
Fig. 3
Fig. 3
Forest plot of diabetes between Delirium and No Delirium groups
Fig. 4
Fig. 4
Forest plot of stroke between Delirium and No Delirium groups
Fig. 5
Fig. 5
Forest plot of dementia between Delirium and No Delirium groups
Fig. 6
Fig. 6
Forest plot of psychiatric illness between Delirium and No Delirium groups
Fig. 7
Fig. 7
Forest plot of hypertension between Delirium and No Delirium groups
Fig. 8
Fig. 8
Forest plot of preoperative MMSE scores between Delirium and No Delirium groups
Fig. 9
Fig. 9
Forest plot of use of sedative-hypnotics between Delirium and No Delirium groups
Fig. 10
Fig. 10
Forest plot of preoperative levels of hemoglobin between Delirium and No Delirium groups
Fig. 11
Fig. 11
Funnel plot of gender (male) between Delirium and No Delirium groups

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