Department of Anesthesiology, Central Theater Command General Hospital of the Chinese People's Liberation Army, Wuhan, China.
Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, China.
Int J Geriatr Psychiatry. 2021 Jan;36(1):3-14. doi: 10.1002/gps.5408. Epub 2020 Oct 29.
Postoperative delirium (POD) is the most common complication in patients after hip fracture surgery, and the incidence of POD is associated with mortality and disability in patients following hip fracture surgery. Therefore, this study aimed to identify the individual as well as anesthetic and operative risk factors associated with the POD in adult patients after hip fracture surgery.
We searched relevant articles published to February 2020 in Cochrane Library, PubMed, and Embase. Studies involving adult patients who underwent hip fracture surgery were regarded as relevant if the studies contained the individual or anesthetic and surgical characteristics of participants. The pooled relative risk ratios (RRs) or weight mean difference of the variables were estimated by the Mantel-Haenszel or Inverse-Variance methods.
A total of 44 studies were included, which altogether included 104572 participants with hip fracture surgery (17703 patients with POD and 86869 patients without POD) and the incidence of POD was 16.93%. A total of 14 risk factors, classified into two categories which were individual as well as anesthetic and operative factors, were identified originally, which included age (weight mean difference [WMD]:2.33;95% confidential interval [CI]: 1.64-3.03), sex (RR: 0.89; 95% CI:0.85-0.93), American society of Anesthesiologists classification(RR:0.56; 95%CI:0.51-0.59), body mass index (WMD:-0.62; 95%CI:-0.81 to -0.44), function dependency(RR:1.52; 95% CI:1.24-1.87), visual impairment (RR:1.62; 95% CI: 1.16-2.27), smoking (RR:0.86; 95% CI:0.79-0.94), preoperative delirium (RR: 2.71; 95% CI: 2.50-2.72), dementia (RR:2.60; 95% CI:2.50-2.72), hypertension (RR: 1.10; 95% CI:1.04-1.15), chronic obstructive pulmonary disease (RR:1.08; 95% CI: 1.01-1.16), regional anesthesia (RR:1.20; 95% CI: 1.01-1.43), transfusion (RR: 1.41; 95% CI: 1.22-1.63), and elective surgery (RR: 0.91; 95% CI: 0.84-0.99).
Patients possessed above risk factors might be high-risk patients. Clinician should maintain keen vigilance at those patients.
术后谵妄（POD）是髋部骨折手术后患者最常见的并发症，POD 的发生率与髋部骨折手术后患者的死亡率和残疾率有关。因此，本研究旨在确定与成人髋部骨折手术后 POD 相关的个体以及麻醉和手术相关的危险因素。
我们检索了 Cochrane 图书馆、PubMed 和 Embase 中截至 2020 年 2 月发表的相关文章。如果研究包含参与者的个体或麻醉和手术特征，则将涉及接受髋部骨折手术的成年患者的研究视为相关研究。使用 Mantel-Haenszel 或Inverse-Variance 方法估计变量的汇总相对风险比（RR）或加权均数差值。
共纳入 44 项研究，共纳入 104572 例髋部骨折手术患者（POD 患者 17703 例，无 POD 患者 86869 例），POD 发生率为 16.93%。最初确定了 14 个危险因素，分为个体以及麻醉和手术因素两类，包括年龄（加权均数差 [WMD]：2.33；95%置信区间 [CI]：1.64-3.03）、性别（RR：0.89；95%CI：0.85-0.93）、美国麻醉师协会分级（RR：0.56；95%CI：0.51-0.59）、体重指数（WMD：-0.62；95%CI：-0.81 至-0.44）、功能依赖性（RR：1.52；95%CI：1.24-1.87）、视力障碍（RR：1.62；95%CI：1.16-2.27）、吸烟（RR：0.86；95%CI：0.79-0.94）、术前谵妄（RR：2.71；95%CI：2.50-2.72）、痴呆（RR：2.60；95%CI：2.50-2.72）、高血压（RR：1.10；95%CI：1.04-1.15）、慢性阻塞性肺疾病（RR：1.08；95%CI：1.01-1.16）、区域麻醉（RR：1.20；95%CI：1.01-1.43）、输血（RR：1.41；95%CI：1.22-1.63）和择期手术（RR：0.91；95%CI：0.84-0.99）。
具有上述危险因素的患者可能是高危患者。临床医生应密切关注这些患者。
