Wang Yiyang, Tang Jun, Zhou Feiya, Yang Lei, Wu Jianbin
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
Medicine (Baltimore). 2017 Jun;96(26):e7361. doi: 10.1097/MD.0000000000007361.
The aim of the current meta-analysis was to assess the treatment effect of comprehensive geriatric care in reducing acute perioperative delirium in older patients with hip fractures, compared with the effect of a routine orthopedic treatment protocol.
We conducted a search of multiple databases to identify randomized controlled trials (RCTs) and quasi-RCTs comparing comprehensive geriatric care and routine orthopedic treatment regarding the following outcomes: incidence of delirium, assessment of cognitive status, and duration of delirium. Odds ratios (ORs) and mean differences (MDs) were pooled using either a fixed-effects or a random-effects model, depending on the heterogeneity of the trials included in the analysis.
Six RCTs and 1 quasi-RCT provided data from 1840 patients. These data revealed that comprehensive geriatric care may reduce the incidence of perioperative delirium (OR = 0.71; 95% confidence interval [CI], 0.57-0.89; P = .003) and that it was associated with higher cognitive status during hospitalization or at 1 month postoperatively (MD = 1.03; 95% CI, 0.93-1.13; P ≤ .00001). There was no significant difference in duration of perioperative delirium between the 2 treatment groups (MD = -2.48; 95% CI, -7.36 to 2.40; P = .32).
Based on the quality of evidence provided, comprehensive geriatric care may reduce the incidence of perioperative delirium. To obtain evidence regarding the merits of comprehensive geriatric care in reducing severity of delirium and shortening the duration of delirium, there is a need for multicenter RCTs with high methodological quality.
本次荟萃分析的目的是评估与常规骨科治疗方案相比，综合老年护理在降低老年髋部骨折患者围手术期急性谵妄方面的治疗效果。
我们检索了多个数据库，以确定比较综合老年护理和常规骨科治疗在以下结局方面的随机对照试验（RCT）和半随机对照试验：谵妄发生率、认知状态评估和谵妄持续时间。根据分析中纳入试验的异质性，采用固定效应模型或随机效应模型汇总比值比（OR）和均值差（MD）。
6项RCT和1项半随机对照试验提供了1840例患者的数据。这些数据显示，综合老年护理可能降低围手术期谵妄的发生率（OR = 0.71；95%置信区间[CI]，0.57 - 0.89；P = 0.003），并且与住院期间或术后1个月时较高的认知状态相关（MD = 1.03；95% CI，0.93 - 1.13；P≤0.00001）。两个治疗组在围手术期谵妄持续时间方面没有显著差异（MD = -2.48；95% CI，-7.36至2.40；P = 0.32）。
基于所提供证据的质量，综合老年护理可能降低围手术期谵妄的发生率。为了获得关于综合老年护理在降低谵妄严重程度和缩短谵妄持续时间方面优点的证据，需要进行方法学质量高的多中心RCT。
