Prevalence and risk factors of postoperative delirium after spinal surgery: a meta-analysis

Hua Gao, Hui-Juan Ma, Ying-Jia Li, Ci Yin, Zheng Li, Hua Gao, Hui-Juan Ma, Ying-Jia Li, Ci Yin, Zheng Li

Abstract

Objective: Postoperative delirium (POD) was common after spinal surgery, but the main findings in previous studies remained conflicting. This current meta-analysis was aimed at exploring the prevalence and risk factors of POD after spinal surgery.

Methods: PubMed and Embase were searched from inception to June 2019. Studies which reported the prevalence and risk factors of POD after spinal surgery were included. STATA version 12.0 was employed to analyze the pooled data. Statistical heterogeneity across included studies was identified using the I2 statistics.

Results: A total of 28 studies with 588,732 patients were included in the meta-analysis. The pooled prevalence of POD after spinal surgery was 0.85% (95%CI, 0.83-0.88%) with substantial heterogeneity (I2 = 97.3%). The central nervous system disorder (OR 4.73; 95%CI, 4.30-5.19) was a strong predictor for POD, whereas age (OR 1.16; 95%CI, 1.05-2.47; I2 = 99.2%) and blood loss (OR 1.10; 95%CI, 1.01-1.20; I2 = 93.3%) were weaker predictors. The funnel plot and statistical tests suggested that there existed potential publication bias, but the trim and fill method indicated that the pooled prevalence basically kept stable after adding two "missing" studies.

Conclusions: The pooled POD after spinal surgery ranges from 0.83 to 0.88%. The central nervous system disorder, age, and blood loss were potential risk factors for POD.

Keywords: Delirium; Meta-analysis; Prevalence, Risk factor; Spinal surgery.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the selection of reports for this meta-analysis
Fig. 2
Fig. 2
Forest plot for incidence of postoperative delirium after spinal surgery. a Fixed-effect model. b Random-effects model
Fig. 3
Fig. 3
Funnel plot of postoperative delirium after spinal surgery (Egger’s test, p = 0.797 and Begg’s test, p = 0.008). a Adjusted funnel plot of postoperative delirium after spinal surgery after adding two “missing” studies from the “trim and fill” analysis (b)

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