Risk prediction models for postoperative delirium in elderly patients with hip fracture: a systematic review

Abstract

Objectives: To systematically evaluate the risk prediction models for postoperative delirium in older adult hip fracture patients.

Methods: Risk prediction models for postoperative delirium in older adult hip fracture patients were collected from the Cochrane Library, PubMed, Web of Science, and Ovid via the internet, covering studies from the establishment of the databases to March 15, 2023. Two researchers independently screened the literature, extracted data, and used Stata 13.0 for meta-analysis of predictive factors and the Prediction Model Risk of Bias Assessment Tool (PROBAST) to evaluate the risk prediction models for postoperative delirium in older adult hip fracture patients, evaluated the predictive performance.

Results: This analysis included eight studies. Six studies used internal validation to assess the predictive models, while one combined both internal and external validation. The Area Under Curve (AUC) for the models ranged from 0.67 to 0.79. The most common predictors were preoperative dementia or dementia history (OR = 3.123, 95% CI 2.108-4.626, p < 0.001), American Society of Anesthesiologists (ASA) classification (OR = 2.343, 95% CI 1.146-4.789, p < 0.05), and age (OR = 1.615, 95% CI 1.387-1.880, p < 0.001). This meta-analysis shows that these were independent risk factors for postoperative delirium in older adult patients with hip fracture.

Conclusion: Research on the risk prediction models for postoperative delirium in older adult hip fracture patients is still in the developmental stage. The predictive performance of some of the established models achieve expectation and the applicable risk of all models is low, but there are also problems such as high risk of bias and lack of external validation. Medical professionals should select existing models and validate and optimize them with large samples from multiple centers according to their actual situation. It is more recommended to carry out a large sample of prospective studies to build prediction models.

Systematic review registration: The protocol for this systematic review was published in the International Prospective Register of Systematic Reviews (PROSPERO) under the registered number CRD42022365258.

Keywords: hip fracture; models; postoperative delirium; prediction; systematic review.

Figure 1

PRISMA flow diagram of study selection process.

Figure 2

Sensitivity analysis for the association between dementia and POD.

Figure 3

Plots for publication bias test in meta-analysis for the association between dementia and POD. (A) Begg’s funnel plot; (B) Egger’s publication bias plot.