Hamilton Gavin M, Wheeler Kathleen, Di Michele Joseph, Lalu Manoj M, McIsaac Daniel I
Department of Anesthesiology and Pain Medicine (G.M.H., M.M.L., D.I.M.), Faculty of Medicine (K.W., J.D.), Regenerative Medicine Program (M.M.L.), Clinical Epidemiology Program (D.I.M.), and The Ottawa Hospital Research Institute (M.M.L., D.I.M.), University of Ottawa, Ottawa, Ontario, Canada.
Anesthesiology. 2017 Jul;127(1):78-88. doi: 10.1097/ALN.0000000000001660.
Delirium is an acute and reversible geriatric syndrome that represents a decompensation of cerebral function. Delirium is associated with adverse postoperative outcomes, but controversy exists regarding whether delirium is an independent predictor of mortality. Thus, we assessed the association between incident postoperative delirium and mortality in adult noncardiac surgery patients.
A systematic search was conducted using Cochrane, MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, and Embase. Screening and data extraction were conducted by two independent reviewers. Pooled-effect estimates calculated with a random-effects model were expressed as odds ratios with 95% CIs. Risk of bias was assessed using the Cochrane Risk of Bias Tool for Non-Randomized Studies.
A total of 34 of 4,968 screened citations met inclusion criteria. Risk of bias ranged from moderate to critical. Pooled analysis of unadjusted event rates (5,545 patients) suggested that delirium was associated with a four-fold increase in the odds of death (odds ratio = 4.12 [95% CI, 3.29 to 5.17]; I = 24.9%). A formal pooled analysis of adjusted outcomes was not possible due to heterogeneity of effect measures reported. However, in studies that controlled for prespecified confounders, none found a statistically significant association between incident postoperative delirium and mortality (two studies in hip fractures; n = 729) after an average follow-up of 21 months. Overall, as study risk of bias decreased, the association between delirium and mortality decreased.
Few high-quality studies are available to estimate the impact of incident postoperative delirium on mortality. Studies that controlled for prespecified confounders did not demonstrate significant independent associations of delirium with mortality.
谵妄是一种急性且可逆的老年综合征，代表脑功能失代偿。谵妄与术后不良结局相关，但谵妄是否为死亡率的独立预测因素仍存在争议。因此，我们评估了成年非心脏手术患者术后发生谵妄与死亡率之间的关联。
使用Cochrane、MEDLINE/PubMed、护理学与健康相关文献累积索引以及Embase进行系统检索。由两名独立评审员进行筛选和数据提取。采用随机效应模型计算的合并效应估计值以比值比及95%置信区间表示。使用Cochrane非随机研究偏倚风险工具评估偏倚风险。
在4968篇筛选出的文献中，共有34篇符合纳入标准。偏倚风险从中度到严重不等。对未调整事件发生率（5545例患者）的合并分析表明，谵妄与死亡几率增加四倍相关（比值比 = 4.12 [95%置信区间，3.29至5.17]；I² = 24.9%）。由于所报告的效应量存在异质性，无法对调整后的结局进行正式的合并分析。然而，在控制了预先设定的混杂因素的研究中，在平均随访21个月后，没有一项研究发现术后发生谵妄与死亡率之间存在统计学显著关联（两项髋部骨折研究；n = 729）。总体而言，随着研究偏倚风险降低，谵妄与死亡率之间的关联也降低。
很少有高质量研究可用于评估术后发生谵妄对死亡率的影响。控制了预先设定的混杂因素的研究未显示谵妄与死亡率之间存在显著的独立关联。
