Incidence and Risk Factors for Postoperative Delirium in Patients Undergoing Spine Surgery: A Systematic Review and Meta-Analysis

BACKGROUND: The present study aims to investigate the incidence and risk factors associated with postoperative delirium in patients undergoing spine surgery. METHODS: PubMed, EMBASE, Cochrane Library, and Science Citation Index were searched up to August 2019 for studies examining postoperative delirium following spine surgery. Incidence and risk factors associated with delirium were extracted. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for outcomes. The Newcastle–Ottawa Scale (NOS) was used for the study quality evaluation. RESULTS: The final analysis includes a total of 40 studies. The pooled analysis reveals that incidence of delirium is 8%, and there are significant differences for developing delirium in age (OR 1.07; 95% CI 1.04–1.09), age more than 65 (OR 4.77; 95% CI 4.37–5.16), age more than 70 (OR 15.87; 95% CI 6.03–41.73), and age more than 80 (OR 1.91; 95% CI 1.78–2.03) years, male (OR 0.81; 95% CI 0.76–0.86), a history of alcohol abuse (OR 2.11; 95% CI 1.67–2.56), anxiety (OR 1.74; 95% CI 1.04–2.44), congestive heart failure (OR 1.4; 95% CI 1.21–1.6), depression (OR 2.5; 95% CI 1.52–3.49), hypertension (OR 1.12; 95% CI 1.04–1.2), kidney disease (OR 1.41; 95% CI 1.16–1.66), neurological disorder (OR 4.66; 95% CI 4.22–5.11), opioid use (OR 1.86; 95% CI 1.18–2.54), psychoses (OR 2.77; 95% CI 2.29–3.25), pulmonary disease (OR 1.81; 95% CI 1.27–2.35), higher mini-mental state examination (OR 0.7; 95% CI 0.5–0.89), preoperative pain (OR 1.88; 95% CI 1.11–2.64), and postoperative urinary tract infection (OR 5.68; 95% CI 2.41–13.39). CONCLUSIONS: A comprehensive understanding of incidence and risk factors of delirium can improve prevention, diagnosis, and management. Risk of postoperative delirium can be reduced based upon identifiable risk factors.