Background

Systematic reviews to date have neglected to exclusively include studies using a validated diagnostic scale for postoperative delirium and monitoring patients for more than 24 h. Evidence on current risk factors is evolving with significantly heterogeneous study designs, inconsistent reporting of results, and a lack of adjustment for bias.

Methods

This systematic review and meta-analysis aimed to identify risk factors for postoperative delirium in an adult patient population. Study designs suitable for this review included full-text articles, RCTs, observational studies, cohort studies, and case-control studies. Extracted variables from the 169 (7.4%) selected studies were included in qualitative synthesis, quantitative synthesis, and a postoperative delirium checklist. The 16 variables included in the checklist were selected based on consistency, direction of effect, number of studies, and clinical utility as a reference for future studies.

Results

A total of 576 variables were extracted, but only six were eligible for meta-analysis. Age (mean difference [MD]=4.94; 95% confidence interval [CI], 2.93–6.94; P<0.001), American Society of Anesthesiologists physical status >2 (odds ratio [OR]=2.27; 95% CI, 1.47–3.52; P<0.001), Charlson Comorbidity Index ≥2 (OR=1.9; 95% CI, 1.11–3.25; P=0.0202), and Mini-Mental State Examination (MD=–1.94; 95% CI, –3.6 to –0.27; P=0.0224) were statistically significant.

Conclusions

Risk factors can assist in clinical decision-making and identification of high-risk patients. Literature analysis identified inconsistent methodology, leading to challenges in interpretation. A standardised format and evidence-based approach should guide future studies.

中文翻译：

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与术后谵妄发生率增加相关的围手术期危险因素：系统回顾、荟萃分析和推荐分级评估、开发和临床文献评价系统报告

背景

迄今为止的系统评价忽略了专门包括使用经过验证的术后谵妄诊断量表和监测患者超过 24 小时的研究。当前风险因素的证据随着研究设计的显着异质性、结果报告的不一致以及缺乏偏倚调整而不断发展。

方法

本系统回顾和荟萃分析旨在确定成年患者术后谵妄的危险因素。适用于本综述的研究设计包括全文文章、随机对照试验、观察性研究、队列研究和病例对照研究。从 169 项 (7.4%) 选定研究中提取的变量包括在定性综合、定量综合和术后谵妄检查表中。检查表中包含的 16 个变量是根据一致性、效果方向、研究数量和临床效用选择的，作为未来研究的参考。

结果

总共提取了 576 个变量，但只有 6 个符合荟萃分析的条件。年龄（平均差 [MD]=4.94；95% 置信区间 [CI]，2.93–6.94；P <0.001），美国麻醉医师协会身体状况 >2（比值比 [OR]=2.27；95% CI，1.47– 3.52；P <0.001），Charlson 合并症指数≥2（OR=1.9；95% CI，1.11–3.25；P =0.0202）和简易精神状态检查（MD=–1.94；95% CI，–3.6 至 – 0.27; P = 0.0224）具有统计学意义。

结论

危险因素可以帮助临床决策和识别高危患者。文献分析确定了不一致的方法，导致解释方面的挑战。标准化格式和循证方法应指导未来的研究。