Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, People's Republic of China.
Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, People's Republic of China.
Aging Clin Exp Res. 2020 Aug;32(8):1417-1434. doi: 10.1007/s40520-019-01319-y. Epub 2019 Aug 30.
Postoperative delirium is common in older patients after spinal surgery. Many reports investigating the risk factors for delirium after spinal surgery have been published recently.
A literature search was performed using the Cochrane Library, Web of Science, PubMed, Embase, and Springer databases from inception to February 2019. Relevant studies involving patients with delirium who underwent spinal surgery were included if the studies contained data about blood transfusion or other related factors, such as haemoglobin, haematocrit, and blood loss levels. The Newcastle-Ottawa Scale was used for the study-quality evaluation. The pooled odds ratios or (standard) mean differences of the individual risk factors were estimated using the Mantel-Haenszel or inverse-variance methods.
Fifteen observational studies met the inclusion criteria; the studies included a total of 583,290 patients (5431 patients with delirium and 577,859 patients without delirium). In addition to an advanced age, the results of the meta-analyses showed that living in an institution, diabetes, cerebral vascular diseases, pulmonary diseases, opioid use, length of surgery, intraoperative blood loss, blood transfusions, intraoperative infusion, preoperative albumin, postoperative albumin, preoperative haematocrit, postoperative haematocrit, preoperative haemoglobin, postoperative haemoglobin, preoperative sodium, postoperative sodium, Mini-Mental State Examination score, inability to ambulate, depression, number of medications, and treatment with multiple drugs (> three types) were significantly associated with delirium.
The above-mentioned risk factors can be used to identify high-risk patients, and the appropriate prophylaxis strategies should be implemented to prevent delirium after spinal surgery.
术后谵妄在接受脊柱手术后的老年患者中很常见。最近有许多关于脊柱手术后谵妄危险因素的报告。
从建库到 2019 年 2 月，我们使用 Cochrane 图书馆、Web of Science、PubMed、Embase 和 Springer 数据库进行了文献检索。如果研究包含有关输血或其他相关因素（如血红蛋白、血细胞比容和失血量）的数据，则纳入了涉及接受脊柱手术并发谵妄的患者的相关研究。采用纽卡斯尔-渥太华量表进行研究质量评估。使用 Mantel-Haenszel 或Inverse-variance 方法估计个体危险因素的合并优势比或（标准）均数差值。
15 项观察性研究符合纳入标准；这些研究共纳入 583290 例患者（5431 例谵妄患者和 577859 例非谵妄患者）。除了年龄较大外，荟萃分析结果还显示，居住在机构中、患有糖尿病、脑血管疾病、肺部疾病、使用阿片类药物、手术时间长、术中失血、输血、术中输液、术前白蛋白、术后白蛋白、术前血细胞比容、术后血细胞比容、术前血红蛋白、术后血红蛋白、术前钠、术后钠、简易精神状态检查评分、无法行走、抑郁、用药种类和使用多种药物（>3 种类型）与谵妄显著相关。
上述危险因素可用于识别高危患者，并应实施适当的预防策略，以预防脊柱手术后发生谵妄。
