Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis

doi:10.3389/fpsyg.2022.993136

. 2022 Sep 30:13:993136.

doi: 10.3389/fpsyg.2022.993136. eCollection 2022.

Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis

Jinlong Zhao^{1

2

3}, Guihong Liang^{1

2

3}, Kunhao Hong⁴, Jianke Pan², Minghui Luo², Jun Liu^{3

4

5}, Bin Huang^{1

2}

Affiliations

¹ The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.
² The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
³ The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
⁴ Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China.
⁵ The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.

PMID: 36248575
PMCID: PMC9565976
DOI: 10.3389/fpsyg.2022.993136

Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis

Jinlong Zhao et al. Front Psychol. 2022.

. 2022 Sep 30:13:993136.

doi: 10.3389/fpsyg.2022.993136. eCollection 2022.

Authors

Jinlong Zhao^{1

2

3}, Guihong Liang^{1

2

3}, Kunhao Hong⁴, Jianke Pan², Minghui Luo², Jun Liu^{3

4

5}, Bin Huang^{1

2}

Affiliations

¹ The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.
² The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
³ The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
⁴ Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China.
⁵ The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.

PMID: 36248575
PMCID: PMC9565976
DOI: 10.3389/fpsyg.2022.993136

Abstract

Objectives: The 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.

Methods: The 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.

Results: In 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).

Conclusions: Multiple 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 registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020170031.

Keywords: meta-analysis; post-operative delirium; risk factor; systematic review; total joint arthroplasty.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**Figure 1**
Flow diagram details the process of relevant clinical study selection.

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References

1. Abengaña J., Chong M. S., Tay L. (2017). Delirium superimposed on dementia: phenomenological differences between patients with and without behavioral and psychological symptoms of dementia in a specialized delirium unit. Int. Psychogeriatr. 29, 485–495. 10.1017/S1041610216001836 - DOI - PubMed
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1. Aziz K. T., Best M. J., Naseer Z., Skolasky R. L., Ponnusamy K. E., Sterling R. S., et al. . (2018). The association of delirium with perioperative complications in primary elective total hip arthroplasty. Clin. Orthop. Surg. 10, 286. 10.4055/cios.2018.10.3.286 - DOI - PMC - PubMed
1. Bosmak F. S., Gibim P. T., Guimaraes S., Ammirati A. L. (2017). Incidence of delirium in postoperative patients treated with total knee and hip arthroplasty. Rev. Assoc. Med. Bras. 63, 248–251. 10.1590/1806-9282.63.03.248 - DOI - PubMed
1. Brown C. H., Max L., LaFlam A., Kirk L., Gross A., Arora R., et al. . (2016). The association between preoperative frailty and postoperative delirium after cardiac surgery. Anesth. Analg. 123, 430–435. 10.1213/ANE.0000000000001271 - DOI - PMC - PubMed

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[1] Abengaña J., Chong M. S., Tay L. (2017). Delirium superimposed on dementia: phenomenological differences between patients with and without behavioral and psychological symptoms of dementia in a specialized delirium unit. Int. Psychogeriatr. 29, 485–495. 10.1017/S1041610216001836 - DOI - PubMed

[2] Abengaña J., Chong M. S., Tay L. (2017). Delirium superimposed on dementia: phenomenological differences between patients with and without behavioral and psychological symptoms of dementia in a specialized delirium unit. Int. Psychogeriatr. 29, 485–495. 10.1017/S1041610216001836 - DOI - PubMed

[3] Allen S. R., Frankel H. L. (2012). Postoperative complications: delirium. Surg. Clin. N. Am. 92, 409–431. 10.1016/j.suc.2012.01.012 - DOI - PubMed

[4] Allen S. R., Frankel H. L. (2012). Postoperative complications: delirium. Surg. Clin. N. Am. 92, 409–431. 10.1016/j.suc.2012.01.012 - DOI - PubMed

[5] Aziz K. T., Best M. J., Naseer Z., Skolasky R. L., Ponnusamy K. E., Sterling R. S., et al. . (2018). The association of delirium with perioperative complications in primary elective total hip arthroplasty. Clin. Orthop. Surg. 10, 286. 10.4055/cios.2018.10.3.286 - DOI - PMC - PubMed

[6] Aziz K. T., Best M. J., Naseer Z., Skolasky R. L., Ponnusamy K. E., Sterling R. S., et al. . (2018). The association of delirium with perioperative complications in primary elective total hip arthroplasty. Clin. Orthop. Surg. 10, 286. 10.4055/cios.2018.10.3.286 - DOI - PMC - PubMed

[7] Bosmak F. S., Gibim P. T., Guimaraes S., Ammirati A. L. (2017). Incidence of delirium in postoperative patients treated with total knee and hip arthroplasty. Rev. Assoc. Med. Bras. 63, 248–251. 10.1590/1806-9282.63.03.248 - DOI - PubMed

[8] Bosmak F. S., Gibim P. T., Guimaraes S., Ammirati A. L. (2017). Incidence of delirium in postoperative patients treated with total knee and hip arthroplasty. Rev. Assoc. Med. Bras. 63, 248–251. 10.1590/1806-9282.63.03.248 - DOI - PubMed

[9] Brown C. H., Max L., LaFlam A., Kirk L., Gross A., Arora R., et al. . (2016). The association between preoperative frailty and postoperative delirium after cardiac surgery. Anesth. Analg. 123, 430–435. 10.1213/ANE.0000000000001271 - DOI - PMC - PubMed

[10] Brown C. H., Max L., LaFlam A., Kirk L., Gross A., Arora R., et al. . (2016). The association between preoperative frailty and postoperative delirium after cardiac surgery. Anesth. Analg. 123, 430–435. 10.1213/ANE.0000000000001271 - DOI - PMC - PubMed

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Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis

Affiliations

Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis

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