Journal
INTERNATIONAL PSYCHOGERIATRICS
Volume 19, Issue 2, Pages 197-214Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S104161020600425X
Keywords
delirium; incidence; orthopedic surgery; meta-analysis; review
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Background: The aim of this study was to perform a systematic review and metaanalysis of the literature regarding the incidence of delirium following orthopedic surgery. Methods: Relevant papers were sourced from online databases and gray literature. Included studies used a validated diagnostic method to measure the incidence of delirium in a prospective sample of adult/elderly orthopedic patients. Data were subject to meta-analysis after stratification by type of surgery (elective v. emergency) and inclusion/exclusion of pre-existing cognitive impairment. A funnel plot assessed for publication bias. Results: 26 publications reported an incidence of postoperative delirium of 453.3% in hip fracture samples and 3.6-28.3% in elective samples. Significant heterogeneity was evident, and this persisted despite stratification. Hip fracture was associated with a higher risk of delirium than elective surgery both when the cognitively impaired were included in the sample (random effects pooled estimate =21.7% [95% CI = 14.6-28.8] vs. 12.1% [95% Cl = 9.6-14.6]), and when the cognitively impaired were excluded (random effects pooled estimate = 25% [95% CI = 15.7-34.7] vs. 8.8% [95% CI = 4.1-13.6]). The funnel plot showed a deficit of small studies showing low risk and large studies showing high risk. In eight hip fracture studies, the proportion of delirium cases with a preoperative onset ranged from 34 to 92%.
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