Study on the predictive model of delirium risk after surgery for elderly hip fractures based on meta-analysis.

IF 3.5 3区 医学 Q2 GERIATRICS & GERONTOLOGY European Geriatric Medicine Pub Date : 2024-11-05 DOI:10.1007/s41999-024-01095-7
Weiliang Wan, Liyun Li, Zhuan Zou, Wenjie Chen
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Abstract

Objective: To develop and validate a risk prediction model for postoperative delirium in elderly patients with hip fractures, aiming to identify high-risk patients and implement preventive measures.

Methods: A systematic search of five authoritative medical databases was conducted, retrieving a total of 1368 relevant articles. After screening, 44 high-quality studies were included in the meta-analysis, analyzing 13 potential risk factors, such as age, gender, diabetes, and history of stroke. A risk prediction model was constructed and validated in a cohort of 189 elderly hip fracture patients. The model's predictive performance was evaluated using ROC curves, with calibration assessed through the Hosmer-Lemeshow test, and clinical utility examined via Decision Curve Analysis (DCA) and Clinical Impact Curves (CIC).

Results: The meta-analysis identified the following as independent risk factors for postoperative delirium: age (≥ 70 years), male gender, diabetes, history of stroke, preoperative comorbidities (≥ 2), previous delirium, preoperative cognitive impairment, low preoperative albumin levels (≤ 40 g/L), prolonged preoperative waiting time (≥ 48 h), anemia (≤ 100 g/L), ASA classification (≥ 3), use of general anesthesia, and prolonged surgery duration (≥ 2 h). The prediction model demonstrated strong efficiency in the validation cohort, with an AUC of 0.956, sensitivity of 87.3%, specificity of 94.8%, and a Brier score of 0.144, indicating high predictive accuracy and calibration. DCA and CIC analyses showed the model to have strong clinical decision-making value and impact across most thresholds.

Conclusion: The risk prediction model developed in this study shows high predictive accuracy and clinical utility, making it valuable for identifying high-risk patients and implementing preventive measures in clinical practice. However, the study has limitations, such as potential retrospective bias, and further validation in larger, multicenter prospective studies is needed to confirm the model's broader applicability and stability.

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基于荟萃分析的老年髋部骨折术后谵妄风险预测模型研究。
目的:开发并验证髋部骨折老年患者术后谵妄的风险预测模型:开发并验证老年髋部骨折患者术后谵妄的风险预测模型,旨在识别高风险患者并采取预防措施:方法:对五个权威医学数据库进行了系统检索,共检索到 1368 篇相关文章。经过筛选,44 项高质量研究被纳入荟萃分析,分析了 13 个潜在风险因素,如年龄、性别、糖尿病和中风病史。构建了一个风险预测模型,并在 189 名老年髋部骨折患者的队列中进行了验证。使用 ROC 曲线评估了该模型的预测性能,通过 Hosmer-Lemeshow 检验评估了校准情况,并通过决策曲线分析(DCA)和临床影响曲线(CIC)检查了临床实用性:荟萃分析确定以下因素为术后谵妄的独立风险因素:年龄(≥ 70 岁)、男性、糖尿病、中风病史、术前合并症(≥ 2)、既往谵妄、术前认知障碍、术前白蛋白水平低(≤ 40 g/L)、术前等待时间长(≥ 48 h)、贫血(≤ 100 g/L)、ASA 分级(≥ 3)、使用全身麻醉和手术时间长(≥ 2 h)。预测模型在验证队列中表现出很高的效率,AUC 为 0.956,灵敏度为 87.3%,特异度为 94.8%,Brier 评分为 0.144,表明预测准确性和校准性都很高。DCA和CIC分析表明,该模型在大多数阈值下都具有很强的临床决策价值和影响:本研究开发的风险预测模型显示出较高的预测准确性和临床实用性,使其在临床实践中对识别高危患者和实施预防措施具有重要价值。然而,该研究也存在一些局限性,如可能存在回顾性偏倚,因此需要在更大规模的多中心前瞻性研究中进一步验证该模型的广泛适用性和稳定性。
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来源期刊
European Geriatric Medicine
European Geriatric Medicine GERIATRICS & GERONTOLOGY-
CiteScore
6.70
自引率
2.60%
发文量
114
审稿时长
6-12 weeks
期刊介绍: European Geriatric Medicine is the official journal of the European Geriatric Medicine Society (EUGMS). Launched in 2010, this journal aims to publish the highest quality material, both scientific and clinical, on all aspects of Geriatric Medicine. The EUGMS is interested in the promotion of Geriatric Medicine in any setting (acute or subacute care, rehabilitation, nursing homes, primary care, fall clinics, ambulatory assessment, dementia clinics..), and also in functionality in old age, comprehensive geriatric assessment, geriatric syndromes, geriatric education, old age psychiatry, models of geriatric care in health services, and quality assurance.
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