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髋关节手术后出现术后谵妄是痴呆发生的潜在危险因素:前瞻性研究的系统评价和荟萃分析。

Postoperative delirium after hip surgery is a potential risk factor for incident dementia: A systematic review and meta-analysis of prospective studies.

机构信息

Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.

Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.

出版信息

Arch Gerontol Geriatr. 2020 Mar-Apr;87:103977. doi: 10.1016/j.archger.2019.103977. Epub 2019 Nov 11.

Abstract

BACKGROUND

Although a few trials have explored the relationship between postoperative delirium (POD) and incident dementia in patients with hip surgery, the numbers of participants in each study are relatively small. Thus, we performed a meta-analysis to examine whether POD after hip surgery is a risk factor for incident dementia.

METHODS

Six prospective cohort studies investigating the development of incident dementia in patients with POD after hip surgery were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- and random- effect models.

RESULTS

POD significantly increased the risk of incident dementia and cognitive decline (overall odds ratio [ORs] = 8.957; 95 % confidence interval [CI], 5.444-14.737; P <  0.001 in fixed-effects model; overall ORs = 8.962; 95 % CI, 5.344-15.029; P <  0.001 in random-effects model). A publication bias was not evident in this study.

CONCLUSIONS

Our meta-analysis revealed that POD after hip surgery is a risk factor for incident dementia. Early identification of cognitive function should be needed after surgery and appropriate prevention and treatment for dementia will be required, especially in cases with POD.

摘要

背景

尽管有几项试验探讨了髋关节手术后术后谵妄(POD)与新发痴呆之间的关系,但每项研究的参与者人数相对较少。因此,我们进行了一项荟萃分析,以检查髋关节手术后 POD 是否是新发痴呆的危险因素。

方法

从 PubMed、Embase 和 Cochrane Library 中检索了六项前瞻性队列研究,这些研究调查了髋关节手术后 POD 患者新发痴呆的发展情况。我们使用固定效应和随机效应模型进行了成对荟萃分析。

结果

POD 显著增加了新发痴呆和认知能力下降的风险(总优势比 [OR] = 8.957;95%置信区间 [CI],5.444-14.737;P<0.001 在固定效应模型中;总 OR = 8.962;95%CI,5.344-15.029;P<0.001 在随机效应模型中)。本研究未发现发表偏倚。

结论

我们的荟萃分析表明,髋关节手术后的 POD 是新发痴呆的一个危险因素。手术后应早期识别认知功能,需要对痴呆症进行适当的预防和治疗,尤其是在发生 POD 的情况下。

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