Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, People's Republic of China.
J Orthop Surg Res. 2021 Jan 22;16(1):76. doi: 10.1186/s13018-020-02127-1.
The risk factors of postoperative delirium (POD), a serious while preventable complication, developed by patients undergoing knee and replacement surgery are still under investigation. In this systematic review and meta-analysis, we identified risk factors associated with POD in knee and hip replacement.
PubMed, Ovid MEDLINE, and Ovid EMBASE were used to identify original researches. The studies evaluating the risk factors of POD after knee and hip replacement were reviewed, and the qualities of the included studies were assessed with Newcastle-Ottawa Scale. Data were extracted, pooled, and a meta-analysis was completed RESULT: Twenty-two studies were finally included with a total of 11934 patients who underwent knee or hip replacement and 1841 developed POD with an incidence of 17.6% (95% confidential interval (CI) 13.2-22.0%). Eighteen significant risk factors were identified including advanced age (odds ratio (OR) 1.15 95% CI 1.08-1.22), cognitive impairment (OR 6.84, 95% CI 3.27-14.33), history of cerebrovascular events (OR 2.51, 95% CI 1.28-4.91), knee replacement (OR 1.42, 95% CI 1.00-2.02), blood loss (standardized mean difference (SMD) 0.30, 95% CI 0.15-0.44), dementia (OR 3.09, 95% CI 2.10-4.56), neurologic disorders (OR 2.26, 95% CI 1.23-4.15), psychiatric illness (OR 2.74, 95% CI 1.34-5.62), and obstructive sleep apnea (OR 4.17, 95% CI 1.72-10.09) along with several comorbidity evaluation scores and laboratory markers.
We identified risk factors consistently associated with the incidence of POD in knee and hip replacement. Strategies and interventions should be implemented to the patients receiving knee or hip replacement with potential risk factors identified in this meta-analysis.
术后谵妄（POD）是一种严重但可预防的并发症，其风险因素仍在研究中。在这项系统评价和荟萃分析中，我们确定了与膝关节和髋关节置换术后 POD 相关的危险因素。
使用 PubMed、Ovid MEDLINE 和 Ovid EMBASE 来确定原始研究。对评估膝关节和髋关节置换术后 POD 危险因素的研究进行了综述，并使用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）对纳入研究的质量进行了评估。提取数据并进行荟萃分析。
最终纳入了 22 项研究，共有 11934 名接受膝关节或髋关节置换术的患者，其中 1841 例发生 POD，发生率为 17.6%（95%置信区间 13.2-22.0%）。确定了 18 个显著的危险因素，包括年龄较大（优势比[OR]1.15，95%置信区间 1.08-1.22）、认知障碍（OR 6.84，95%置信区间 3.27-14.33）、脑血管事件史（OR 2.51，95%置信区间 1.28-4.91）、膝关节置换术（OR 1.42，95%置信区间 1.00-2.02）、失血量（标准化均数差[SMD]0.30，95%置信区间 0.15-0.44）、痴呆（OR 3.09，95%置信区间 2.10-4.56）、神经疾病（OR 2.26，95%置信区间 1.23-4.15）、精神疾病（OR 2.74，95%置信区间 1.34-5.62）和阻塞性睡眠呼吸暂停（OR 4.17，95%置信区间 1.72-10.09）以及几个合并症评估评分和实验室标志物。
我们确定了与膝关节和髋关节置换术后 POD 发生率一致相关的危险因素。应针对接受膝关节或髋关节置换术且存在本荟萃分析中确定的潜在危险因素的患者实施策略和干预措施。
