Risk factors for postoperative delirium after spinal surgery: a systematic review and meta-analysis
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REVIEW
Risk factors for postoperative delirium after spinal surgery: a systematic review and meta‑analysis Chao Zhu1 · Bin Wang1 · Jian Yin1 · Qingmei Xue1 · Shan Gao1 · Linyu Xing2 · Hua Wang1 · Wei Liu1 · Xinhui Liu1 Received: 26 April 2019 / Accepted: 13 August 2019 © Springer Nature Switzerland AG 2019
Abstract Background Postoperative delirium is common in older patients after spinal surgery. Many reports investigating the risk factors for delirium after spinal surgery have been published recently. Methods A literature search was performed using the Cochrane Library, Web of Science, PubMed, Embase, and Springer databases from inception to February 2019. Relevant studies involving patients with delirium who underwent spinal surgery were included if the studies contained data about blood transfusion or other related factors, such as haemoglobin, haematocrit, and blood loss levels. The Newcastle–Ottawa Scale was used for the study-quality evaluation. The pooled odds ratios or (standard) mean differences of the individual risk factors were estimated using the Mantel–Haenszel or inverse-variance methods. Results Fifteen observational studies met the inclusion criteria; the studies included a total of 583,290 patients (5431 patients with delirium and 577,859 patients without delirium). In addition to an advanced age, the results of the meta-analyses showed that living in an institution, diabetes, cerebral vascular diseases, pulmonary diseases, opioid use, length of surgery, intraoperative blood loss, blood transfusions, intraoperative infusion, preoperative albumin, postoperative albumin, preoperative haematocrit, postoperative haematocrit, preoperative haemoglobin, postoperative haemoglobin, preoperative sodium, postoperative sodium, Mini-Mental State Examination score, inability to ambulate, depression, number of medications, and treatment with multiple drugs (> three types) were significantly associated with delirium. Conclusion The above-mentioned risk factors can be used to identify high-risk patients, and the appropriate prophylaxis strategies should be implemented to prevent delirium after spinal surgery. Keywords Delirium · Postoperative · Spinal surgery · Risk factors
Introduction Chao Zhu, Bin Wang, and Jian Yin have contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40520-019-01319-y) contains supplementary material, which is available to authorized users. * Xinhui Liu [email protected] Jian Yin [email protected] 1
Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, People’s Republic of China
Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, People’s Republic of China
2
Delirium is defined as acute turbidity of consciousness and is associated with underlying physiological disorders. Delirium is a multifactorial and heterogeneous syndrome associated with high morbidity and economic costs [1–3]. Postoperative
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