Abstract
BackgroundThe 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.MethodsPubMed, 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 completedResultTwenty-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.ConclusionWe 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.
Highlights
The risk factors of postoperative delirium (POD), a serious while preventable complication, developed by patients undergoing knee and replacement surgery are still under investigation
A metaanalysis revealed that 17% of patients who underwent total knee or hip replacement surgery developed POD [8], and a systematic review summarized that general anesthesia, advanced age, history of psychiatric illness, decreased functional status, and specific anesthetic agents would raise the POD rate [9]
Risk factors Advanced age A total of 15 studies reported the mean age in POD and non-POD groups, and a pooled standardized mean differences (SMDs) revealed that POD patients were mildly older (Fig. 3a, SMD 0.43 years, 95% confidential intervals (CIs) 0.24–0.61, p < 0.001, I2 = 73.4%) than the non-POD patients
Summary
The risk factors of postoperative delirium (POD), a serious while preventable complication, developed by patients undergoing knee and replacement surgery are still under investigation. There would be 512,000 hip replacement and 700,000 knee replacement in the USA [1, 2], and the demand continues to grow worldwide for the outcomes are satisfying based on pain relief and function improvement These procedures are performed in the age group of those older than 60 years [1, 2]. As an acute decline in cognitive function, POD is serious and costly which mainly affects elderly people aged 65 years and older with an incidence rate of 12–51% in orthopedic surgery [3] It is associated with an increase in mortality and morbidity, prolonged length of hospital stay, and worse surgical outcomes [3, 4]. The existing meta-analysis and systematic reviews have not provided the pooled estimation of risk factors or only summarized the incidence of POD in the knee and hip replacement
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