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

Abstract

Objective Postoperative 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. Methods PubMed 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. Results A 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. Conclusions The 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.

Risk assessment of perioperative neurocognitive disorders, where are we now?

“…older age, comorbidity, cognitive impairment/dementia, history of alcohol abuse or cerebrovascular events) [2] and are consistent with the known model of predisposing and precipitating factors. However, four points are worth mentioning: First, a low incidence of delirium has been reported by some authors [4 ▪ ,5,6 ▪▪ ], which might be due to the fact that in some studies [5,6 ▪▪ ] POD was assessed based on ICD-9 codes and/or billing for certain antipsychotics but not on routine testing using generally accepted tests such as the Confusion Assessment Method (CAM) or the Intensive Care Delirium Screening Checklist (ICDSC). Hence, manypatients–especially those with hypoactive delirium–might have been left undiagnosed.…”

Risk factors of delirium after gastrointestinal surgery: A meta‐analysis

“…However, postoperative delirium can be prevented if its risk factors are identified through research and reduced before and after surgeries (Cole et al, 1996; Demeure & Fain, 2006). Several meta‐analyses have reported risk factors for postoperative delirium, mostly in patients undergoing cardiac or orthopaedic surgery (Chen et al, 2021; Gao et al, 2020; Rong et al, 2021). Reported risk factors include patient characteristics (advanced age and sex), preoperative factors (history of postoperative delirium, cerebrovascular events, cognitive impairment, neurologic disorders, sleep disorders, dementia, hypertension, depression and diabetes), intraoperative factors (blood loss, intensive care unit stay, operating time and operative approach) and postoperative factors (fever, low haemoglobin, low albumin and low potassium) (Chen et al, 2021; Galyfos et al, 2017; Gao et al, 2020; Rong et al, 2021; Zhang et al, 2020).…”

Preoperative heart rate variability analysis is as a potential simple and easy measure for predicting perioperative delirium in esophageal surgery

“…It is important to identify an examination method that can be performed easily before the starting of acute or intensive care in consideration of each patient's factor. Preoperative assessment should be mandatory [ 4 , 8 , 9 ]. Moreover, if it can be predicted by preoperative measurement which patients will have postoperative delirium, prevention of developing delirium might appropriately save the medical cost.…”