Prevalence and risk factors of postoperative delirium after spinal surgery: a meta-analysis

Hua Gao,Zheng Li,Ying-Jia Li,Ci Yin,Hui-Juan Ma

doi:10.1186/s13018-020-01651-4

Abstract

ObjectivePostoperative delirium (POD) was common after spinal surgery, but the main findings in previous studies remained conflicting. This current meta-analysis was aimed at exploring the prevalence and risk factors of POD after spinal surgery.MethodsPubMed and Embase were searched from inception to June 2019. Studies which reported the prevalence and risk factors of POD after spinal surgery were included. STATA version 12.0 was employed to analyze the pooled data. Statistical heterogeneity across included studies was identified using the I2 statistics.ResultsA total of 28 studies with 588,732 patients were included in the meta-analysis. The pooled prevalence of POD after spinal surgery was 0.85% (95%CI, 0.83–0.88%) with substantial heterogeneity (I2 = 97.3%). The central nervous system disorder (OR 4.73; 95%CI, 4.30–5.19) was a strong predictor for POD, whereas age (OR 1.16; 95%CI, 1.05–2.47; I2 = 99.2%) and blood loss (OR 1.10; 95%CI, 1.01–1.20; I2 = 93.3%) were weaker predictors. The funnel plot and statistical tests suggested that there existed potential publication bias, but the trim and fill method indicated that the pooled prevalence basically kept stable after adding two “missing” studies.ConclusionsThe pooled POD after spinal surgery ranges from 0.83 to 0.88%. The central nervous system disorder, age, and blood loss were potential risk factors for POD.

Highlights

Delirium, an acute state of confusion, is characterized as the distortion in consciousness and perception, decreased capacity of focusing one’s attention, deteriorated cognitive functions, and disturbed sleep-wake cycles [1, 2]
An accurate estimate of incidence may help to identify some certain subgroups of patients, which would attract more attention of doctors to adjust interventions for the specific patient populations, and it may guide researchers to establish the scientific inclusion of clinical trials, matching the interventional and control groups well in terms of Postoperative delirium (POD)-associated baseline risk variables
All eligible observational studies, which reported the incidence of delirium after spinal surgery or provided relevant information to calculate the incidence of POD, were assessed for inclusion in this meta-analysis

Summary

Introduction

An acute state of confusion, is characterized as the distortion in consciousness and perception, decreased capacity of focusing one’s attention, deteriorated cognitive functions, and disturbed sleep-wake cycles [1, 2]. Gao et al Journal of Orthopaedic Surgery and Research (2020) 15:138 a further exploration on the POD-associated risk factors after spinal surgery. An accurate estimation of the POD incidence is of much significance. In the intervention studies without a placebo group, a precise estimate of incidence is needed for comparison to determine whether the intervention could effectively prevent POD. An accurate estimate of incidence may help to identify some certain subgroups of patients, which would attract more attention of doctors to adjust interventions for the specific patient populations, and it may guide researchers to establish the scientific inclusion of clinical trials, matching the interventional and control groups well in terms of POD-associated baseline risk variables. Currently, the reported prevalences of POD vary too widely following spinal surgery with inconsistency

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Results

Conclusion