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The incidence of delirium associated with orthopedic surgery: a meta-analytic review

International Psychogeriatrics, ISSN: 1041-6102, Vol: 19, Issue: 2, Page: 197-214
2007
  • 278
    Citations
  • 0
    Usage
  • 182
    Captures
  • 0
    Mentions
  • 0
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    278
    • Citation Indexes
      272
    • Policy Citations
      5
      • Policy Citation
        5
    • Clinical Citations
      1
      • PubMed Guidelines
        1
  • Captures
    182

Review Description

Background: The aim of this study was to perform a systematic review and meta analysis of the literature regarding the incidence of delirium following orthopedic surgery. Methods: Relevant papers were sourced from online databases and gray literature. Included studies used a validated diagnostic method to measure the incidence of delirium in a prospective sample of adult/elderly orthopedic patients. Data were subject to meta-analysis after stratification by type of surgery (elective v. emergency) and inclusion/exclusion of pre-existing cognitive impairment. A funnel plot assessed for publication bias. Results: 26 publications reported an incidence of postoperative delirium of 4— 53.3% in hip fracture samples and 3.6-28.3% in elective samples. Significant heterogeneity was evident, and this persisted despite stratification. Hip fracture was associated with a higher risk of delirium than elective surgery both when the cognitively impaired were included in the sample (random effects pooled estimate = 21.7% [95% CI=14.6-28.8]vs. 12.1% [95% CI=9.6-14.6]),and when the cognitively impaired were excluded (random effects pooled estimate =25% [95% CI=15.7-34.7]vs. 8.8% [95% CI=4.1-13.6]). The funnel plot showed a deficit of small studies showing low risk and large studies showing high risk. In eight hip fracture studies, the proportion of delirium cases with a preoperative onset ranged from 34 to 92%. Conclusions: Delirium occurs more commonly with hip fracture than elective surgery, and frequently has a preoperative onset when associated with trauma. Recommendations are made with the aim of standardizing future research in order to further explore and reduce the heterogeneity and possible publication bias observed.

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