Preoperative risk factors for postoperative delirium following hip fracture repair: a systematic review

International Journal of Geriatric Psychiatry - Tập 30 Số 9 - Trang 900-910 - 2015
Esther S. Oh1,2,3,4, Meng Li5, Tolulope Fafowora1, Sharon K. Inouye6,7, Cathy Chen8, Lori Rosman9, Constantine G. Lyketsos3, Frederick E. Sieber10, Milo A. Puhan11,4
1Department of Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA
2Department of Pathology, John Hopkins University School of Medicine, Baltimore, MD, USA
3Department of Psychiatry and Behavioral Sciences, John Hopkins University School of Medicine, Baltimore, MD, USA
4Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
5Pharmaceutical Outcomes Research & Policy Program, University of Washington, Seattle, WA, USA
6Aging Brain Center, Institute of Aging Research, Hebrew SeniorLife, Boston, MA, USA
7Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
8Princeton University, Princeton, NJ, USA
9Department of Welch Medical Library, John Hopkins University School of Medicine, Baltimore, MD, USA
10Department of Anesthesiology and Critical Care Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA
11Institute of Social & Preventive Medicine University of Zurich Zurich Switzerland

Tóm tắt

ObjectiveSystematically identify preoperative clinical risk factors for incident postoperative delirium in individuals undergoing hip fracture repair in order to guide clinicians in identifying high risk patients at admission.MethodsThis is a systematic review of prospective observational studies with estimation of association between preoperative risk factors and incident postoperative delirium in multivariate models. Electronic searches were conducted in PubMed, Embase, PsycINFO, CINAHL, Cochrane Library, Proquest Dissertations and Theses, and WorldCatDissertations. Hand searches were conducted in selected journals and their supplements.ResultsSearch yielded 6380 titles and abstracts from electronic databases and 72 titles from hand searches, and 10 studies met inclusion criteria. The following risk factors were significant in bivariate models: cognitive impairment, age, gender, institutionalization, functional impairment, body mass index (BMI), albumin, comorbidities, American Society of Anesthesiologist classification, acute medical conditions, polypharmacy, and vision impairment. Among all of these risk factors, cognitive impairment most consistently remained statistically significant after adjusting for other risk factors in multivariate models, followed by BMI/albumin and multiple comorbidities.ConclusionIn our systematic review, cognitive impairment was one of the strongest preoperative risk factors for postoperative delirium after hip fracture surgery. Preoperative cognitive assessment may be one of the most useful methods of identifying those who are at high risk for postoperative delirium and prioritizing delivery of delirium prevention measures. Copyright © 2014 John Wiley & Sons, Ltd.

Từ khóa


Tài liệu tham khảo

10.1136/pgmj.2003.017236

10.1002/1099-1166(200101)16:1<7::AID-GPS261>3.0.CO;2-W

10.1093/aje/kwp266

10.1080/00016470410001123

BjoroK.2008.Pain treatment: a risk factor for delirium in older adult with hip fracture.

10.1017/S104161020600425X

Centers for Disease Control and Prevention.1996.Incidence and costs to Medicare of fractures among Medicare beneficiaries aged >65 years—United States July 1991–June 1992.45:877–883.

10.1007/BF01623184

10.1111/j.1532-5415.2006.00893.x

10.1016/0022-3956(75)90026-6

10.1001/jama.1990.03440080075027

10.1111/j.1479-8301.2006.00146.x

10.1093/gerona/63.7.764

10.1001/jama.1996.03530350034031

10.1111/j.1532-5415.2000.tb03885.x

10.1056/NEJM199903043400901

10.1192/bjp.123.4.467

10.1017/S003329170002691X

10.1111/j.1532-5415.2009.02377.x

10.2215/CJN.03090509

10.1016/j.jpsychores.2013.10.006

10.1111/j.1532-5415.2011.03725.x

10.1016/j.jpsychores.2008.05.019

10.1046/j.1532-5415.2001.49108.x

10.1111/j.1532-5415.2000.tb04718.x

Moher D, 2009, Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement, Ann Intern Med, 151, W64

10.1093/gerona/58.1.M76

10.1001/jamainternmed.2014.2362

10.1016/j.archger.2011.09.012

10.1093/ageing/afp024

10.1016/j.expneurol.2006.01.018

10.1111/j.1532-5415.2010.03243.x

10.1159/000087311

10.1111/j.1532-5415.2011.03729.x

10.1007/s00198-013-2375-9

10.1176/jnp.13.2.229

10.1213/00000539-200206000-00050

Thông tin
Thông tin xuất bản

International Journal of Geriatric Psychiatry

Tập 30 Số 9

900-910

Thông tin tác giả