Risk factors of postoperative delirium following spine surgery: A meta-analysis of 50 cohort studies with 1.1 million participants
Mingjiang Luo,
Di Wang,
Yuxin Shi,
Qilong Yi,
Zhongze Wang,
Beijun Zhou,
Gaigai Yang,
Juemiao Chen,
Can Liang,
Haoyun Wang,
Xin Zeng,
Yuxin Yang,
Ridong Tan,
Yudie Xie,
Jiang Chen,
Siliang Tang,
Jinshan Huang,
Zubing Mei,
Zhihong Xiao
Affiliations
Mingjiang Luo
The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Di Wang
The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China; Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Yuxin Shi
Department of Pediatric Dentistry, First Affiliated Hospital (Affiliated Stomatological Hospital) of Xinjiang Medical University, Urumqi 830054, China
Qilong Yi
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Zhongze Wang
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Beijun Zhou
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Gaigai Yang
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Juemiao Chen
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Can Liang
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Haoyun Wang
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Xin Zeng
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Yuxin Yang
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Ridong Tan
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Yudie Xie
Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Jiang Chen
The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Siliang Tang
The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Jinshan Huang
The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
Zubing Mei
The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China; Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; Anorectal Disease Institute of Shuguang Hospital, Shanghai, China; Corresponding author. Department of spine surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421000, China; Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital, Shanghai 201203, China.
Zhihong Xiao
The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China; Corresponding author. Department of spine surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421000, China.
Objectives: Postoperative delirium (POD) is considered to be a common complication of spine surgery. Although many studies have reported the risk factors associated with POD, the results remain unclear. Therefore, we performed a meta-analysis to identify risk factors for POD among patients following spinal surgery. Methods: We systematically searched the PubMed, Embase and the Cochrane Library for relevant articles published from 2006 to February 1, 2023 that reported risk factors associated with the incidence of POD among patients undergoing spinal surgery. The Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed, and random effects models were used to estimate pooled odds ratio (OR) estimates with 95 % confidence intervals (CIs) for each factor. The evidence from observational studies was classified according to Egger's P value, total sample size, and heterogeneity between studies. Results: Of 11,329 citations screened, 50 cohort studies involving 1,182,719 participants met the inclusion criteria. High-quality evidence indicated that POD was associated with hypertension, diabetes mellitus, cardiovascular disease, pulmonary disease, older age (>65 years), patients experiencing substance use disorder (take drug ≥1 month), cerebrovascular disease, kidney disease, neurological disorder, parkinsonism, cervical surgery, surgical site infection, postoperative fever, postoperative urinary tract infection, and admission to the intensive care unit (ICU). Moderate-quality evidence indicated that POD was associated with depression, American Society of Anesthesiologists (ASA) fitness grade (>II), blood transfusion, abnormal potassium, electrolyte disorder, length of stay, inability to ambulate and intravenous fluid volume. Conclusions: Conspicuous risk factors for POD were mainly patient- and surgery-related. These findings help clinicians identify high-risk patients with POD following spinal surgery and recognize the importance of early intervention.
