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Association between postoperative delirium and mortality in elderly patients undergoing hip fractures surgery: a meta-analysis

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Abstract

Introduction

Postoperative delirium (POD) is a common complication in elderly surgical patients. Patients undergoing hip fractures surgery who are often characterized by advanced age could be particularly prone to suffering POD. We performed a meta-analysis to assess the association between POD and mortality in elderly patients undergoing hip fractures surgery.

Summary

This meta-analysis included twenty-one cohort studies, and the pooled outcomes demonstrated that approximated one-fourth of patients undergoing hipfracture surgery would develop POD, and delirium increased the mortality in these patients.

Methods

We searched PubMed, Embase, Web of Science, and Scopus for studies that investigated the effect of POD on mortality in elderly patients undergoing hip fracture surgery. Two reviewers independently selected studies, assessed quality, and extracted data. Statistical analyses were performed by STATA 14.0 and RevMan 5.3. Risk ratios (RRs) with 95% confidence intervals (CIs) were derived using random or fixed-effects model.

Results

Twenty-one cohort studies enrolling a total of 6288 patients were included, and the pooled prevalence (95% CI) of POD was 28% (23–34%). POD was associated with an increase in perioperative mortality (30-day or in-hospital mortality) [12 studies, 3123 patients, relative risk (RR) (95% CI) 2.79 (1.97–3.93)], 6-month mortality [6 studies, 1673 patients, 2.51 (1.99–3.16)], 1-year mortality [6 studies, 1896 patients, 1.98 (1.62–2.41)], and more than 1-year mortality [8 studies, 1926 patients, 2.06 (1.60–2.64)].

Conclusions

Our meta-analysis demonstrated that approximated one-fourth of patients undergoing hip fracture surgery would develop POD, and delirium increased the short-term and long-term mortality in these patients.

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Abbreviations

POD:

Postoperative delirium

RR:

Relative risk

CI:

Confidence interval

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Acknowledgments

We thank the authors of the included studies for their helping.

Funding

This study was supported by National Natural Science Foundation of China: (81772332); Natural Science Foundation of Jiangsu Province (BK20141281), Special Foundation Project on the Prospective Study of Social Development in Jiangsu Province (BE2013911), Jiangsu Six Categories of Talent Summit Fund (WSW-133), Social Development of Science and Technology Research Project in Yangzhou (YZ2011082), and Jiangsu Province 333 talent Project (BRA2016159).

Author information

Authors and Affiliations

  1. Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China

    J. Bai

  2. Department of Orthopedics, Northern Jiangsu People’s Hospital, Clinical Medical College of Yangzhou University, Nantong West Road 98, Yangzhou, 225001, China

    Y. Liang, J. He, J. Wang & Y. Wang

  3. Department of Orthopedics, The Second XiangYa Hospital, Central South University, Changsha, 410011, China

    P. Zhang

  4. Educational Administration Section, The Second Hospital of Dalian Medical University, Dalian, 116027, China

    X. Liang

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Contributions

JC Wang, YX Wang, and JZ Bai conceived of the design of the study. P Zhang and Y Liang participated in the literature search and study selection. JS He and JZ Bai participated in data extraction and quality assessment. XY Liang and Y Liang performed the statistical analysis. JZ Bai finished the manuscript. All the authors read and approved the final manuscript.

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Correspondence to J. Wang or Y. Wang.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Jianzhong Bai and Yuan Liang are Co-first author.

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Appendix S1

. The details of the search strategy from PubMed, Embase, Web of Science, and Scopus (DOCX 29 kb).

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Bai, J., Liang, Y., Zhang, P. et al. Association between postoperative delirium and mortality in elderly patients undergoing hip fractures surgery: a meta-analysis. Osteoporos Int 31, 317–326 (2020). https://doi.org/10.1007/s00198-019-05172-7

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