Association between postoperative delirium and mortality in elderly patients undergoing hip fractures surgery: a meta-analysis
- 84 Downloads
Postoperative delirium (POD) is a common complication in elderly surgical patients. Patients undergoing hip fractures surgery who are often characterized by advanced age could be particularly prone to suffering POD. We performed a meta-analysis to assess the association between POD and mortality in elderly patients undergoing hip fractures surgery.
This meta-analysis included twenty-one cohort studies, and the pooled outcomes demonstrated that approximated one-fourth of patients undergoing hipfracture surgery would develop POD, and delirium increased the mortality in these patients.
We searched PubMed, Embase, Web of Science, and Scopus for studies that investigated the effect of POD on mortality in elderly patients undergoing hip fracture surgery. Two reviewers independently selected studies, assessed quality, and extracted data. Statistical analyses were performed by STATA 14.0 and RevMan 5.3. Risk ratios (RRs) with 95% confidence intervals (CIs) were derived using random or fixed-effects model.
Twenty-one cohort studies enrolling a total of 6288 patients were included, and the pooled prevalence (95% CI) of POD was 28% (23–34%). POD was associated with an increase in perioperative mortality (30-day or in-hospital mortality) [12 studies, 3123 patients, relative risk (RR) (95% CI) 2.79 (1.97–3.93)], 6-month mortality [6 studies, 1673 patients, 2.51 (1.99–3.16)], 1-year mortality [6 studies, 1896 patients, 1.98 (1.62–2.41)], and more than 1-year mortality [8 studies, 1926 patients, 2.06 (1.60–2.64)].
Our meta-analysis demonstrated that approximated one-fourth of patients undergoing hip fracture surgery would develop POD, and delirium increased the short-term and long-term mortality in these patients.
KeywordsDelirium Elderly Hip fracture Meta-analysis Mortality
We thank the authors of the included studies for their helping.
JC Wang, YX Wang, and JZ Bai conceived of the design of the study. P Zhang and Y Liang participated in the literature search and study selection. JS He and JZ Bai participated in data extraction and quality assessment. XY Liang and Y Liang performed the statistical analysis. JZ Bai finished the manuscript. All the authors read and approved the final manuscript.
This study was supported by National Natural Science Foundation of China: (81772332); Natural Science Foundation of Jiangsu Province (BK20141281), Special Foundation Project on the Prospective Study of Social Development in Jiangsu Province (BE2013911), Jiangsu Six Categories of Talent Summit Fund (WSW-133), Social Development of Science and Technology Research Project in Yangzhou (YZ2011082), and Jiangsu Province 333 talent Project (BRA2016159).
Compliance with Ethical Standards
Ethics approval and consent to participate
This article does not contain any studies with human participants or animals performed by any of the authors.
Conflicts of interest
- 3.Zywiel MG, Hurley RT, Perruccio AV, Hancock-Howard RL, Coyte PC, Rampersaud YR (2015) Health economic implications of perioperative delirium in older patients after surgery for a fragility hip fracture. J Bone Joint Surg Am 97(10):829–836. https://doi.org/10.2106/jbjs.N.00724 CrossRefPubMedGoogle Scholar
- 8.G. A. Wells, B. Shea, D. O'Connell et al. (2017) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses,” http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
- 11.Olofsson B, Persson M, Bellelli G, Morandi A, Gustafson Y, Stenvall M (2018) Development of dementia in patients with femoral neck fracture who experience postoperative delirium-a three-year follow-up study. Int J Geriatr Psychiatry 33(4):623–632. https://doi.org/10.1002/gps.4832 CrossRefPubMedGoogle Scholar
- 12.Bellelli G, Carnevali L, Corsi M, Morandi A, Zambon A, Mazzola P, Galeazzi M, Bonfanti A, Massariello F, Szabo H, Oliveri G, Haas J, d'Oro LC, Annoni G (2018) The impact of psychomotor subtypes and duration of delirium on 6-month mortality in hip-fractured elderly patients. Int J Geriatr Psychiatry. https://doi.org/10.1002/gps.4914 CrossRefGoogle Scholar
- 13.Ruggiero C, Bonamassa L, Pelini L, Prioletta I, Cianferotti L, Metozzi A, Benvenuti E, Brandi G, Guazzini A, Santoro GC, Mecocci P, Black D, Brandi ML (2017) Early post-surgical cognitive dysfunction is a risk factor for mortality among hip fracture hospitalized older persons. Osteoporos Int 28(2):667–675. https://doi.org/10.1007/s00198-016-3784-3 CrossRefPubMedGoogle Scholar
- 16.Radinovic K, Markovic-Denic L, Dubljanin-Raspopovic E, Marinkovic J, Milan Z, Bumbasirevic V (2015) Estimating the effect of incident delirium on short-term outcomes in aged hip fracture patients through propensity score analysis. Geriatr Gerontol Int 15(7):848–855. https://doi.org/10.1111/ggi.12358 CrossRefPubMedGoogle Scholar
- 36.Watt J, Tricco AC, Talbot-Hamon C, Pham B, Rios P, Grudniewicz A, Wong C, Sinclair D, Straus SE (2018) Identifying older adults at risk of delirium following elective surgery: a systematic review and meta-analysis. J Gen Intern Med 33(4):500–509. https://doi.org/10.1007/s11606-017-4204-x CrossRefPubMedPubMedCentralGoogle Scholar
- 37.American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults (2015) J Am Geriatr Soc 63 (1):142-150. doi: https://doi.org/10.1111/jgs.13281
- 39.Mason SE, Noel-Storr A, Ritchie CW (2010) The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis 22(Suppl 3):67–79. https://doi.org/10.3233/jad-2010-101086 CrossRefPubMedGoogle Scholar
- 40.Sharma PT, Sieber FE, Zakriya KJ, Pauldine RW, Gerold KB, Hang J, Smith TH (2005) Recovery room delirium predicts postoperative delirium after hip-fracture repair. Anesth Analg 101(4):1215–1220, table of contents. https://doi.org/10.1213/01.ane.0000167383.44984.e5 CrossRefPubMedGoogle Scholar
- 44.Tomasi CD, Salluh J, Soares M, Vuolo F, Zanatta F, Constantino Lde S, Zugno AI, Ritter C, Dal-Pizzol F (2015) Baseline acetylcholinesterase activity and serotonin plasma levels are not associated with delirium in critically ill patients. Rev Bras Ter Intensiva 27(2):170–177. https://doi.org/10.5935/0103-507x.20150029 CrossRefPubMedPubMedCentralGoogle Scholar