背景:术后谵妄是皮瓣移植手术的严重并发症,对手术预后产生不利影响。术后谵妄复杂的病理生理学使得阐明其危险因素具有挑战性。本研究旨在通过系统回顾和荟萃分析来描述接受游离皮瓣重建的癌症患者术后谵妄的患病率和特定危险因素,以启发积极的预防措施。
方法:研究人员系统地查询了国际和中文数据库。从开始到2023年9月14日,使用术语“游离组织皮瓣,\“\”谵妄,\"\"肿瘤,“和”风险因素。使用StataSE(15.0版)进行数据合成和统计分析,以计算已识别风险因素的综合效应大小。报告的结果包括加权平均差或比值比及其各自95%置信区间。
结果:纳入了12项病例对照研究(ntotal=3,256)。其中,515例患者在游离皮瓣手术后出现术后谵妄,与2,741名没有这样做的患者相比。结果表明,风险因素包括但不限于年龄,男性,晚期肿瘤分期,使用催眠药或抗精神病药,背景疾病的历史,精神病学审查,气管切开术,伤口愈合受损。相比之下,早期肿瘤分期等是具有统计学意义的保护因素。多变量分析进一步确定术前白蛋白,围手术期输血,睡眠障碍,术后视觉模拟量表,术后白蛋白,吸烟,术后谵妄的出现。
结论:确定的危险因素分为术前,术中,和术后类别由当前数据证实,以提供术后谵妄预防说明。
BACKGROUND: Postoperative delirium is a severe complication of flap transplantation surgery, adversely affecting surgical prognoses. The intricate pathophysiology of postoperative delirium renders the elucidation of its risk factors challenging. This research aims to delineate the prevalence and the specific risk factors of postoperative delirium in patients with cancer undergoing free flap reconstruction through a systematic review and meta-analysis to enlighten proactive prevention measures.
METHODS: The researchers systematically queried both the international and Chinese databases. Searches were performed for publications from inception until September 14, 2023, using the terms \"free tissue flaps,\" \"delirium,\" \"neoplasms,\" and \"risk factors.\" Data synthesis and statistical analysis were conducted using Stata SE (version 15.0) to calculate the combined effect size for identified risk factors. Reported outcomes included weighted mean differences or odds ratios with their respective 95% confidence intervals.
RESULTS: Twelve
case-control studies were included (ntotal = 3,256). Among them, 515 patients developed postoperative delirium after free flap surgery, compared with 2,741 patients who did not. The outcomes suggest that the risk factors include but are not limited to age, male, late neoplasm staging, use of hypnotic or antipsychotic, history of background diseases, psychiatric review, tracheotomy, and impaired wound healing. In contrast, early neoplasm staging and others are the protective factors with statistical significance. Multivariate analysis further identified significant correlations between preoperative albumin, perioperative blood transfusion, sleep disturbance, postoperative visual analog scale, postoperative albumin, smoking, and the appearance of postoperative delirium.
CONCLUSIONS: The determined risk factors were grouped into preoperative, intraoperative, and postoperative categories substantiated by current data to present instructions for postoperative delirium prevention.