Predictors of postoperative delirium in elderly patients following total hip and knee arthroplasty: a systematic review and meta-analysis

Quan Zhou,Mingzhuang Hou,Huilin Yang,Xin Tian,Yijian Zhang,Tao Liu,Xinfeng Zhou,Xi Chen,Fan He

doi:10.1186/s12891-021-04825-1

Abstract

BackgroundPostoperative delirium (POD) is widely reported as a common postoperative complication following total joint arthroplasty (TJA) of the hip and knee in elderly patients, leading to many adverse effects. We sought to investigate predictors of delirium after TJA.MethodsPubMed, EMBASE, Cochrane Library and Web of Science were searched up to 2020 for studies examining POD following TJA in elderly patients. Pooled odds ratio (OR) and mean difference (MD) of those who experienced delirium compared to those who did not were calculated for each variable. The Newcastle-Ottawa Scale (NOS) was used for the study quality evaluation.ResultsFifteen studies with 31 potential factors were included. In the primary analysis, 9 factors were associated with POD, comprising advanced age (MD 3.81; 95% confidence interval (CI) 1.80–5.83), dementia (OR 24.85; 95% CI 7.26–85.02), hypertension (OR 2.26; 95% CI 1.31–3.89), diabetes (OR 2.02; 95% CI 1.15–3.55), stroke (OR 14.61; 95% CI 5.26–40.55), psychiatric illness (OR 2.72; 95% CI 1.45–5.08), use of sedative-hypnotics (OR 6.42; 95% CI 2.53–16.27), lower preoperative levels of hemoglobin (MD − 0.56; 95% CI − 0.89−− 0.22), and lower preoperative mini-mental state examination score (MD − 0.40; 95% CI − 0.69−− 0.12). Twelve studies were included in the systematic review, of which 24 factors were additionally correlated with POD using single studies.ConclusionsStrategies and interventions should be implemented for the elderly patients receiving TJA surgeries with potential predictors identified in this meta-analysis.

Highlights

Postoperative delirium (POD) is widely reported as a common postoperative complication following total joint arthroplasty (TJA) of the hip and knee in elderly patients, leading to many adverse effects
21 articles that did not use the standard diagnosis of delirium (DSM or Confusion Assessment Method (CAM)) were excluded
9 factors were strongly associated with POD, including comprising advanced age, dementia, hypertension, diabetes, stroke, psychiatric illness, use of sedative-hypnotics, lower preoperative levels of hemoglobin, and lower preoperative mini-mental state examination score

Summary

Introduction

Postoperative delirium (POD) is widely reported as a common postoperative complication following total joint arthroplasty (TJA) of the hip and knee in elderly patients, leading to many adverse effects. Total joint arthroplasty (TJA) remains one of the most effective modern surgical interventions for pain relief and functional recovery. It is estimated that the demand for hip arthroplasty procedures is projected to rise by almost twofold in 2030, while that for knee arthroplasty procedures by almost. Postoperative delirium (POD), as a sudden, transient disturbance of attention, perception, and consciousness, is one of the widely reported complications after TJA [3]. The reported incidence of POD in total hip arthroplasty ranges from 8.4 to 18.1%, and 12.8–30.5% in total knee arthroplasty [5]. The disparately reported incidence of delirium after surgery is dependent on diagnostic criteria for delirium, frequency of assessment, and the qualifications and experience of the assessors [5]

Methods

Results

Discussion

Conclusion