Data_Sheet_1_Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis.docx

ObjectivesThe purpose of this study was to identify risk factors for delirium after total joint arthroplasty (TJA) and provide theoretical guidance for reducing the incidence of delirium after TJA.
MethodsThe protocol for this meta-analysis is registered with PROSPERO (CRD42020170031). We searched PubMed, the Cochrane Library and Embase for observational studies on risk factors for delirium after TJA. Review Manager 5.3 was used to calculate the relative risk (RR) or standard mean difference (SMD) of potential risk factors related to TJA. STATA 14.0 was used for quantitative publication bias evaluation.
ResultsIn total, 25 studies including 3,767,761 patients from 9 countries were included. Old age has been widely recognized as a risk factor for delirium. Our results showed that the main risk factors for delirium after TJA were patient factors (alcohol abuse: RR = 1.63; length of education: SMD = −0.93; and MMSE score: SMD = −0.39), comorbidities (hypertension: RR = 1.26; diabetes mellitus: RR = 1.67; myocardial infarction: RR = 17.75; congestive heart failure: RR = 2.54; dementia: RR = 17.75; renal disease: RR = 2.98; history of stroke: RR = 4.83; and history of mental illness: RR = 2.36), surgical factors (transfusion: RR = 1.53; general anesthesia: RR = 1.10; pre-operative albumin: SMD = −0.38; pre-operative hemoglobin: SMD = −0.29; post-operative hemoglobin: SMD = −0.24; total blood loss: SMD = 0.15; duration of surgery: SMD = 0.29; and duration of hospitalization: SMD = 2.00) and drug factors (benzodiazepine use: RR = 2.14; ACEI use: RR = 1.52; and beta-blocker use: RR = 1.62).
ConclusionsMultiple risk factors were associated with delirium after TJA. These results may help doctors predict the occurrence of delirium after surgery and determine the correct treatment.
Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42020170031.

研究目的：本研究旨在明确全关节置换术（total joint arthroplasty, TJA）术后谵妄的危险因素，并为降低全关节置换术后谵妄的发生率提供理论指导。
研究方法：本项荟萃分析的方案已在PROSPERO平台注册（注册号：CRD42020170031）。我们检索了PubMed、Cochrane图书馆及Embase数据库中关于全关节置换术后谵妄危险因素的观察性研究。采用Review Manager 5.3软件计算与全关节置换相关的潜在危险因素的相对危险度（relative risk, RR）或标准化均数差（standard mean difference, SMD）；采用STATA 14.0软件进行定量的发表偏倚评估。
研究结果：本研究共纳入来自9个国家的25项观察性研究，涉及3767761例患者。高龄已被广泛认可为谵妄的危险因素。本研究结果显示，全关节置换术后谵妄的主要危险因素可分为以下几类：患者自身因素（酗酒：相对危险度RR=1.63；受教育时长：标准化均数差SMD=-0.93；简易精神状态检查量表（Mini-Mental State Examination, MMSE）得分：SMD=-0.39）、合并症因素（高血压：RR=1.26；糖尿病：RR=1.67；心肌梗死：RR=17.75；充血性心力衰竭：RR=2.54；痴呆：RR=17.75；肾脏疾病：RR=2.98；卒中病史：RR=4.83；精神疾病病史：RR=2.36）、手术相关因素（输血：RR=1.53；全身麻醉：RR=1.10；术前白蛋白水平：SMD=-0.38；术前血红蛋白水平：SMD=-0.29；术后血红蛋白水平：SMD=-0.24；总失血量：SMD=0.15；手术时长：SMD=0.29；住院时长：SMD=2.00）以及药物相关因素（苯二氮䓬类药物使用：RR=2.14；血管紧张素转换酶抑制剂（Angiotensin-Converting Enzyme Inhibitor, ACEI）使用：RR=1.52；β受体阻滞剂使用：RR=1.62）。
研究结论：多种危险因素与全关节置换术后谵妄存在关联。本研究结果有助于临床医生预测术后谵妄的发生并制定合理的诊疗方案。
系统评价注册信息：https://www.crd.york.ac.uk/prospero/，注册号：CRD42020170031。