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A systematic review and meta-analysis of the correlation between operation time and postoperative delirium in total
Gaoxiang Zhang1, Zhongwei Wang2, Dengcheng Wang2
1Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Orthopedics, Beijing Tongzhou District Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China.
Background:
Delirium is a common postoperative complication of total hip arthroplasty (THA), excessively long time surgery may be one of the factors associated with it. This article aimed to employ literature retrieval and meta-analysis to investigate the correlation between operation time and postoperative delirium in THA.
Methods:
The databases of PubMed and Springerlink libraries were searched for retrospective case-control studies on delirium-related factors after THA. The retrieved studies were screened according to the inclusion criteria. Newcastle-Ottawa scale (NOS) was used to assess the quality of literatures. After extracting the data of included literatures, RevMan 5.3.5 software was used to analyze the data and obtain a forest plot and funnel plot.
Results:
A total of 137 literatures were initially screened in this study. According to the inclusion and exclusion criteria and literature quality evaluation, 6 studies were finally included, involving a total of 3,494 patients. The NOS scores were above 6 points in all 6 literatures. Meta-analysis revealed statistical heterogeneity among the 6 studies (I2=80%, P=0.0002). The random effects model was used, revealing that the operation time of patients with postoperative delirium was longer, and the difference was statistically significant [standardized mean difference (SMD) =0.43, 95% confidence interval (CI): 0.20 to 0.66, P=0.0003]. The 6 studies were divided into unilateral or bilateral THA subgroups according to the type of surgery. Homogeneity was detected between the internal literatures: bilateral subgroup (I2=5%, P=0.37), unilateral subgroup (I2=0%, P=0.78). Postoperative delirium was associated with longer operation time in both subgroups, which was consistent with the combined analysis: bilateral subgroup (SMD =0.25, 95% CI: 0.12 to 0.37, P=0.0001), unilateral subgroup (SMD =0.70, 95% CI: 0.55 to 0.84, P=0.0001).
Discussion:
Operation time is one of the related factors of delirium after THA. The longer the operation time, the greater the possibility of delirium.
