Bruce Angela J, Ritchie Craig W, Blizard Robert, Lai Rosalind, Raven Peter
Waitemata District Health Board, Auckland, New Zealand.
Int Psychogeriatr. 2007 Apr;19(2):197-214. doi: 10.1017/S104161020600425X. Epub 2006 Sep 14.
The aim of this study was to perform a systematic review and meta-analysis of the literature regarding the incidence of delirium following orthopedic surgery.
Relevant papers were sourced from online databases and gray literature. Included studies used a validated diagnostic method to measure the incidence of delirium in a prospective sample of adult/elderly orthopedic patients. Data were subject to meta-analysis after stratification by type of surgery (elective v. emergency) and inclusion/exclusion of pre-existing cognitive impairment. A funnel plot assessed for publication bias.
26 publications reported an incidence of postoperative delirium of 4-53.3% in hip fracture samples and 3.6-28.3% in elective samples. Significant heterogeneity was evident, and this persisted despite stratification. Hip fracture was associated with a higher risk of delirium than elective surgery both when the cognitively impaired were included in the sample (random effects pooled estimate = 21.7% [95% CI = 14.6-28.8] vs. 12.1% [95% CI = 9.6-14.6]), and when the cognitively impaired were excluded (random effects pooled estimate = 25% [95% CI = 15.7-34.7] vs. 8.8% [95% CI = 4.1-13.6]). The funnel plot showed a deficit of small studies showing low risk and large studies showing high risk. In eight hip fracture studies, the proportion of delirium cases with a preoperative onset ranged from 34 to 92%.
Delirium occurs more commonly with hip fracture than elective surgery, and frequently has a preoperative onset when associated with trauma. Recommendations are made with the aim of standardizing future research in order to further explore and reduce the heterogeneity and possible publication bias observed.
本研究旨在对有关骨科手术后谵妄发生率的文献进行系统评价和荟萃分析。
从在线数据库和灰色文献中获取相关论文。纳入的研究采用经过验证的诊断方法，对成年/老年骨科患者的前瞻性样本中的谵妄发生率进行测量。数据在按手术类型（择期手术与急诊手术）以及是否纳入/排除既往存在的认知障碍进行分层后进行荟萃分析。采用漏斗图评估发表偏倚。
26篇出版物报告了髋部骨折样本中术后谵妄的发生率为4% - 53.3%，择期手术样本中为3.6% - 28.3%。明显存在显著异质性，且尽管进行了分层，这种异质性仍然存在。当样本中纳入认知障碍患者时，髋部骨折与谵妄的较高风险相关（随机效应合并估计值 = 21.7% [95%置信区间 = 14.6% - 28.8%] 对比12.1% [95%置信区间 = 9.6% - 14.6%]），当排除认知障碍患者时也是如此（随机效应合并估计值 = 25% [95%置信区间 = 15.7% - 34.7%] 对比8.8% [95%置信区间 = 4.1% - 13.6%]）。漏斗图显示小型低风险研究和大型高风险研究数量不足。在八项髋部骨折研究中，术前发作的谵妄病例比例在34%至92%之间。
与择期手术相比，髋部骨折后谵妄更常见，并且在与创伤相关时通常术前就已发作。为了进一步探索并减少所观察到的异质性和可能的发表偏倚，提出了旨在规范未来研究的建议。
