Risk factors for postoperative delirium after oral and maxillofacial surgery: a Meta-analysis

doi:10.3877/cma.j.issn.1674-1366.2019.03.006

Abstract

Abstract:

Objective

In order to provide evidence for the effective clinical prevention of postoperative delirium (POD) , this study analyzed the related risk factors of POD after oral and maxillofacial surgery.

Methods

Databases including Web of Science, PubMed, Cochrane Library and EMbase were included in the searching of literatures about delirium after oral and maxillofacial surgery. The searching period was from the establishment of the databases to July 1st, 2018. The literatures were screened strictly according to the included and excluded criteria, and their quality was evaluated afterwards. POD′s related factors were extracted as available data. Statistical analysis was carried out by using RevMan 5.3 and StataSE 12.0.

Results

In total, 11 original studies with 2429 patients were included, in which 415 patients (17.1%) suffered from POD. The results showed that age, gender, solitary life, mental status, history of hypertension, preoperative hemoglobin and total protein, intraoperative anesthesia time, operation time, blood loss, tracheotomy, postoperative pain were risk factors for delirium after oral and maxillofacial surgery (P<0.05) , while smoking, alcoholism, ASA scale, diabetes mellitus, heart disease, preoperative serum sodium, preoperative albumin, infusion volume, neck dissection, free flap transfer were not significantly correlated (P>0.05) .

Conclusions

Patients′ age, gender, mental status, hypertension and related laboratory results (preoperative hemoglobin, total protein) should be paid close attention before oral and maxillofacial surgery. Factors including anesthesia time, operation time, bleeding and ventilation should be strictly controlled. Besides, postoperative analgesia should be well managed since it can effectively prevent POD.

Key words: Oral and maxillofacial, Surgery, oral, Delirium, postoperative

Xiaoning Yu, Jiechen Cai, Lihao Huang, Yue Zhu, Jinsong Hou. Risk factors for postoperative delirium after oral and maxillofacial surgery: a Meta-analysis[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2019, 13(03): 166-173.

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Figures/Tables 3

References 42

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纳入文献	诊断方法	谵妄/非谵妄	研究设计	质量评估（分）	影响因素
Booka 2016^[8]	DSM-Ⅴ	50/243	回顾性研究	8	年龄、男性、吸烟、饮酒、精神状态、ASA分级、心脏病、高血压、糖尿病、输液量、手术时间、失血量、皮瓣转移修复术、气管切开
Choi 2017^[9]	DSM-Ⅳ	89/252	回顾性研究	9	年龄、精神状态、ASA分级、麻醉时间、气管切开、睡眠障碍、术前血清钠、术前白蛋白
Hasegawa 2015^[10]	DSM-Ⅳ	29/159	队列研究	8	年龄、男性、吸烟、饮酒、精神状态、心脏病、高血压、糖尿病、住院天数、手术时间、失血量、颈淋巴清扫术、气管切开、术前血清钠、术前血红蛋白、术前白蛋白、术前总蛋白
Kinugawa 2018^[11]	临床诊断	6/40	回顾性研究	8	年龄、男性、精神状态、高血压、住院天数、麻醉时间、手术时间、失血量、术前血红蛋白、术前总蛋白
Kunimatsu 2004^[12]	ICD-10	13/23	回顾性研究	8	年龄、男性、ASA分级、麻醉时间、手术时间
Makiguchi 2018^[13]	DSM-Ⅳ	34/68	队列研究	7	年龄、男性、吸烟、饮酒、精神状态、ASA分级、糖尿病、输液量、手术时间、失血量、睡眠障碍、术前血红蛋白、术前白蛋白、术前总蛋白
Shah 2012^[14]	临床诊断	89/685	队列研究	8	男性、独居、饮酒、精神状态
Shiiba 2009^[15]	DSM-Ⅳ	24/108	回顾性研究	7	年龄、男性、麻醉时间、输液量、手术时间、失血量、皮瓣转移修复术、气管切开、疼痛、术前血清钠、术前血红蛋白、术前白蛋白、术前总蛋白
Wang 2004^[16]	DSM-Ⅲ	47/294	回顾性研究	8	年龄、男性、颈淋巴清扫术、皮瓣转移修复术
Weed 1995^[17]	MMSE	24/114	队列研究	7	年龄、男性、独居、饮酒、精神状态、心脏病、ASA分级、住院时间、麻醉时间、颈淋巴清扫术、皮瓣转移修复术
Yamagata 2005^[18]	临床诊断	10/28	回顾性研究	7	年龄、男性、独居、吸烟、饮酒、精神状态、ASA分级、输液量、手术时间、颈淋巴清扫术、皮瓣转移修复术、气管切开、疼痛

纳入文献	诊断方法	谵妄/非谵妄	研究设计	质量评估（分）	影响因素
Booka 2016^[8]	DSM-Ⅴ	50/243	回顾性研究	8	年龄、男性、吸烟、饮酒、精神状态、ASA分级、心脏病、高血压、糖尿病、输液量、手术时间、失血量、皮瓣转移修复术、气管切开
Choi 2017^[9]	DSM-Ⅳ	89/252	回顾性研究	9	年龄、精神状态、ASA分级、麻醉时间、气管切开、睡眠障碍、术前血清钠、术前白蛋白
Hasegawa 2015^[10]	DSM-Ⅳ	29/159	队列研究	8	年龄、男性、吸烟、饮酒、精神状态、心脏病、高血压、糖尿病、住院天数、手术时间、失血量、颈淋巴清扫术、气管切开、术前血清钠、术前血红蛋白、术前白蛋白、术前总蛋白
Kinugawa 2018^[11]	临床诊断	6/40	回顾性研究	8	年龄、男性、精神状态、高血压、住院天数、麻醉时间、手术时间、失血量、术前血红蛋白、术前总蛋白
Kunimatsu 2004^[12]	ICD-10	13/23	回顾性研究	8	年龄、男性、ASA分级、麻醉时间、手术时间
Makiguchi 2018^[13]	DSM-Ⅳ	34/68	队列研究	7	年龄、男性、吸烟、饮酒、精神状态、ASA分级、糖尿病、输液量、手术时间、失血量、睡眠障碍、术前血红蛋白、术前白蛋白、术前总蛋白
Shah 2012^[14]	临床诊断	89/685	队列研究	8	男性、独居、饮酒、精神状态
Shiiba 2009^[15]	DSM-Ⅳ	24/108	回顾性研究	7	年龄、男性、麻醉时间、输液量、手术时间、失血量、皮瓣转移修复术、气管切开、疼痛、术前血清钠、术前血红蛋白、术前白蛋白、术前总蛋白
Wang 2004^[16]	DSM-Ⅲ	47/294	回顾性研究	8	年龄、男性、颈淋巴清扫术、皮瓣转移修复术
Weed 1995^[17]	MMSE	24/114	队列研究	7	年龄、男性、独居、饮酒、精神状态、心脏病、ASA分级、住院时间、麻醉时间、颈淋巴清扫术、皮瓣转移修复术
Yamagata 2005^[18]	临床诊断	10/28	回顾性研究	7	年龄、男性、独居、吸烟、饮酒、精神状态、ASA分级、输液量、手术时间、颈淋巴清扫术、皮瓣转移修复术、气管切开、疼痛

因素	文献数	病例数	谵妄人数	统计学方法	OR或MD［95% CI］	异质性I²（%）	P值
年龄	10	1655	326	Ⅳ.random	5.61［3.11，8.10］	85	<0.0001
年龄>70岁	3	772	121	M-H.fixed	2.60［1.71，3.97］	33	<0.0001
男性	10	2088	326	M-H.fixed	1.79［1.35，2.38］	46	<0.0001
独居	3	950	123	M-H.fixed	1.60［1.03，2.47］	60	0.03
吸烟	4	621	123	M-H.fixed	1.19［0.78，1.82］	27	0.42
酗酒	6	1533	236	M-H.fixed	1.05［0.79，1.39］	54	0.76
精神状态	8	1920	331	M-H.random	2.97［1.45，6.79］	61	0.003
ASA分级	5	810	196	Ⅳ.random	0.16［-0.01，0.34］	73	0.06
高血压	3	527	85	M-H.fixed	1.93［1.17，3.18］	0	0.01
糖尿病	3	583	113	M-H.random	2.45［0.50，12.12］	86	0.27
心脏病	3	619	103	M-H.fixed	0.95［0.47，1.93］	30	0.89
麻醉时间	5	693	156	Ⅳ.random	65.89［18.19，113.59］	75	0.007
输液量	4	565	118	Ⅳ.fixed	178.80［-46.68，404.27］	0	0.12
手术时间	7	835	166	Ⅳ.random	82.53［36.50，128.56］	67	0.0004
失血量	5	761	143	Ⅳ.fixed	61.23［19.88，102.59］	48	0.004
颈淋巴清扫术	4	705	110	M-H.fixed	1.29［0.85，1.96］	61	0.23
皮瓣转移修复术	4	810	131	M-H.fixed	1.53［0.98，2.37］	39	0.06
气管切开术	5	992	202	M-H.fixed	1.89［1.35，2.66］	0	0.0002
睡眠障碍	2	443	123	M-H.random	4.98［1.36，18.27］	76	0.02
疼痛	2	170	34	M-H.fixed	2.91［1.23，6.92］	0	0.02
住院天数	3	372	59	Ⅳ.random	7.58［2.00，13.16］	71	8
术前血清钠	3	661	142	Ⅳ.fixed	0.15［-0.37，0.66］	20	0.58
术前血红蛋白	4	468	93	Ⅳ.random	-2.27［-7.17，2.63］	67	0.36
术前白蛋白	4	763	176	Ⅳ.random	-0.53［-3.22，2.17］	89	0.7
术前总蛋白	4	468	93	Ⅳ.random	-1.29［-5.01，2.42］	87	0.5

因素	文献数	病例数	谵妄人数	统计学方法	OR或MD［95% CI］	异质性I²（%）	P值
年龄	10	1655	326	Ⅳ.random	5.61［3.11，8.10］	85	<0.0001
年龄>70岁	3	772	121	M-H.fixed	2.60［1.71，3.97］	33	<0.0001
男性	10	2088	326	M-H.fixed	1.79［1.35，2.38］	46	<0.0001
独居	3	950	123	M-H.fixed	1.60［1.03，2.47］	60	0.03
吸烟	4	621	123	M-H.fixed	1.19［0.78，1.82］	27	0.42
酗酒	6	1533	236	M-H.fixed	1.05［0.79，1.39］	54	0.76
精神状态	8	1920	331	M-H.random	2.97［1.45，6.79］	61	0.003
ASA分级	5	810	196	Ⅳ.random	0.16［-0.01，0.34］	73	0.06
高血压	3	527	85	M-H.fixed	1.93［1.17，3.18］	0	0.01
糖尿病	3	583	113	M-H.random	2.45［0.50，12.12］	86	0.27
心脏病	3	619	103	M-H.fixed	0.95［0.47，1.93］	30	0.89
麻醉时间	5	693	156	Ⅳ.random	65.89［18.19，113.59］	75	0.007
输液量	4	565	118	Ⅳ.fixed	178.80［-46.68，404.27］	0	0.12
手术时间	7	835	166	Ⅳ.random	82.53［36.50，128.56］	67	0.0004
失血量	5	761	143	Ⅳ.fixed	61.23［19.88，102.59］	48	0.004
颈淋巴清扫术	4	705	110	M-H.fixed	1.29［0.85，1.96］	61	0.23
皮瓣转移修复术	4	810	131	M-H.fixed	1.53［0.98，2.37］	39	0.06
气管切开术	5	992	202	M-H.fixed	1.89［1.35，2.66］	0	0.0002
睡眠障碍	2	443	123	M-H.random	4.98［1.36，18.27］	76	0.02
疼痛	2	170	34	M-H.fixed	2.91［1.23，6.92］	0	0.02
住院天数	3	372	59	Ⅳ.random	7.58［2.00，13.16］	71	8
术前血清钠	3	661	142	Ⅳ.fixed	0.15［-0.37，0.66］	20	0.58
术前血红蛋白	4	468	93	Ⅳ.random	-2.27［-7.17，2.63］	67	0.36
术前白蛋白	4	763	176	Ⅳ.random	-0.53［-3.22，2.17］	89	0.7
术前总蛋白	4	468	93	Ⅳ.random	-1.29［-5.01，2.42］	87	0.5

因素	Galbraithe图提示存在异质性的研究	排除异质性研究后统计合并效应		P值	Egger检验
因素	Galbraithe图提示存在异质性的研究	OR或MD［95% CI］	异质性I²（%）	P值	Egger检验
年龄	Choi 2017	3.18［1.95，4.41］	77	<0.0001	0.068
	Hasegawa 2015	?	?	?	?
	Kinugawa 2018	?	?	?	?
独居	n.s.	1.60［1.03，2.47］	60	0.03	0.611
酗酒	n.s.	1.05［0.79，1.39］	54	0.76	0.751
精神状态	Hasegawa 2015	2.91［1.84，4.58］	40	<0.0001	0.272
精神状态	Kinugawa 2018	?	?	?	?
ASA分级	Booka 2016	0.08［-0.06，0.22］	45	0.24	0.486
糖尿病	Makiguchi 2018	1.23［0.45，3.35］	38	0.69	0.699
麻醉时间	Kinugawa 2018	45.76［20.80，70.73］	31	0.0003	0.09
手术时间	Kinugawa 2018	51.45［10.77，94.14］	37	0.01	0.918
手术时间	Yamagata 2005	?	?	?	?
颈淋巴清扫术	n.s.	1.29［0.85，1.96］	61	0.23	0.947
住院天数	Hasegawa 2015	n.s.	n.s.	n.s.	n.s.
住院天数	Weed 1995	?	?	?	?
术后睡眠障碍	n.s.	4.98［1.36，18.27］	76	0.02	n.s.
术前血红蛋白	Makiguchi 2018	-4.70［-7.67，-1.73］	0	0.002	0.366
术前白蛋白	Hasegawa 2015	-1.04［-2.13，0.05］	0	0.06	0.778
术前白蛋白	Makiguchi 2018	?	?	?	?
术前总蛋白	Hasegawa 2015	-2.42［-4.39，-0.45］	0	0.02	0.653
术前总蛋白	Makiguchi 2018	?	?	?	?

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