Fu Donglin, Tan Xiaoyu, Zhang Meng, Chen Liang, Yang Jin
Intensive Care Unit, Chongqing General Hospital, University of Chinese Academy of Sciences, No. 118 Xingguang Avenue, Liangjiang New Area, Chongqing, 400010, China.
Department of Urology, Chongqing University Central Hospital, Chongqing, 400010, China.
Aging Clin Exp Res. 2022 Jan;34(1):25-37. doi: 10.1007/s40520-021-01828-9. Epub 2021 Apr 8.
Frailty has been suggested as a possible risk factor for postoperative delirium (POD). However, results of previous studies were not consistent. We performed a meta-analysis of cohort study to evaluate the above association.
Relevant studies were obtained via systematic search of PubMed, Embase, SCOPUS, and Web of Science databases. Only studies with multivariate analysis were included. A random-effect model incorporating the potential heterogeneity was used to combine the results.
Fifteen cohort studies including 3250 adult patients who underwent surgery were included, and the prevalence of frailty was 27.1% (880/3250) before surgeries. Overall, POD occurred in 513 patients (15.8%). Pooled results showed that frailty was associated with a higher risk of POD (adjusted odds ratio [OR]: 3.23, 95% confidence interval [CI]: 2.56-4.07, P < 0.001) without significant heterogeneity (P for Cochrane's Q test = 0.25, I = 18%). Subgroup analyses showed a more remarkable association between frailty and POD in prospective cohort studies (OR: 3.64, 95% CI: 2.95-4.49, P < 0.001) than that in retrospective cohort studies (OR: 2.32, 95% CI: 1.60-3.35, P < 0.001; P for subgroup difference = 0.04). Moreover, the association was not affected by country of the study, age group of the patient, elective or emergency surgeries, cardiac and non-cardiac surgeries, evaluation instruments for frailty, diagnostic methods for POD, or quality score of the study (P for subgroup difference all > 0.05).
Frailty may be associated with a higher risk of POD in adult population.
衰弱被认为是术后谵妄（POD）的一个潜在风险因素。然而，先前研究的结果并不一致。我们进行了一项队列研究的荟萃分析，以评估上述关联。
通过系统检索PubMed、Embase、SCOPUS和Web of Science数据库获取相关研究。仅纳入进行了多变量分析的研究。采用纳入潜在异质性的随机效应模型合并结果。
纳入了15项队列研究，共3250例接受手术的成年患者，术前衰弱患病率为27.1%（880/3250）。总体而言，513例患者（15.8%）发生了POD。汇总结果显示，衰弱与POD风险较高相关（调整后的优势比[OR]：3.23，95%置信区间[CI]：2.56 - 4.07，P < 0.001），且无显著异质性（Cochrane's Q检验的P值 = 0.25，I² = 18%）。亚组分析显示，在前瞻性队列研究中，衰弱与POD之间的关联（OR：3.64，95% CI：2.95 - 4.49，P < 0.001）比回顾性队列研究中更显著（OR：2.32，95% CI：1.60 - 3.35，P < 0.001；亚组差异的P值 = 0.04）。此外，该关联不受研究国家、患者年龄组、择期或急诊手术、心脏和非心脏手术、衰弱评估工具、POD诊断方法或研究质量评分的影响（亚组差异的P值均 > 0.05）。
在成年人群中，衰弱可能与POD风险较高相关。
