{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:36:18Z","timestamp":1792024578552,"version":"4.4.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T00:00:00Z","timestamp":1664496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The purpose of this study was to identify risk factors for delirium after total joint arthroplasty (TJA) and provide theoretical guidance for reducing the incidence of delirium after TJA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The protocol for this meta-analysis is registered with PROSPERO (CRD42020170031). We searched PubMed, the Cochrane Library and Embase for observational studies on risk factors for delirium after TJA. Review Manager 5.3 was used to calculate the relative risk (RR) or standard mean difference (SMD) of potential risk factors related to TJA. STATA 14.0 was used for quantitative publication bias evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 25 studies including 3,767,761 patients from 9 countries were included. Old age has been widely recognized as a risk factor for delirium. Our results showed that the main risk factors for delirium after TJA were patient factors (alcohol abuse: RR = 1.63; length of education: SMD = \u22120.93; and MMSE score: SMD = \u22120.39), comorbidities (hypertension: RR = 1.26; diabetes mellitus: RR = 1.67; myocardial infarction: RR = 17.75; congestive heart failure: RR = 2.54; dementia: RR = 17.75; renal disease: RR = 2.98; history of stroke: RR = 4.83; and history of mental illness: RR = 2.36), surgical factors (transfusion: RR = 1.53; general anesthesia: RR = 1.10; pre-operative albumin: SMD = \u22120.38; pre-operative hemoglobin: SMD = \u22120.29; post-operative hemoglobin: SMD = \u22120.24; total blood loss: SMD = 0.15; duration of surgery: SMD = 0.29; and duration of hospitalization: SMD = 2.00) and drug factors (benzodiazepine use: RR = 2.14; ACEI use: RR = 1.52; and beta-blocker use: RR = 1.62).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Multiple risk factors were associated with delirium after TJA. These results may help doctors predict the occurrence of delirium after surgery and determine the correct treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p><jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>, identifier: CRD42020170031.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyg.2022.993136","type":"journal-article","created":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T10:32:17Z","timestamp":1664533937000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":37,"title":["Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Jinlong","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guihong","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunhao","family":"Hong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianke","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minghui","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1017\/S1041610216001836","article-title":"Delirium superimposed on dementia: phenomenological differences between patients with and without behavioral and psychological symptoms of dementia in a specialized delirium unit","volume":"29","author":"Abenga\u00f1a","year":"2017","journal-title":"Int. Psychogeriatr."},{"key":"B2","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/j.suc.2012.01.012","article-title":"Postoperative complications: delirium","volume":"92","author":"Allen","year":"2012","journal-title":"Surg. Clin. N. Am."},{"key":"B3","doi-asserted-by":"publisher","first-page":"286","DOI":"10.4055\/cios.2018.10.3.286","article-title":"The association of delirium with perioperative complications in primary elective total hip arthroplasty","volume":"10","author":"Aziz","year":"2018","journal-title":"Clin. Orthop. Surg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1590\/1806-9282.63.03.248","article-title":"Incidence of delirium in postoperative patients treated with total knee and hip arthroplasty","volume":"63","author":"Bosmak","year":"2017","journal-title":"Rev. Assoc. Med. Bras."},{"key":"B5","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1213\/ANE.0000000000001271","article-title":"The association between preoperative frailty and postoperative delirium after cardiac surgery","volume":"123","author":"Brown","year":"2016","journal-title":"Anesth. Analg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"6607386","DOI":"10.1155\/2021\/6607386","article-title":"Risk factors and a nomogram model establishment for postoperative delirium in elderly patients undergoing arthroplasty surgery: a single-center retrospective study","volume":"2021","author":"Chen","year":"","journal-title":"Biomed. Res. Int."},{"key":"B7","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1186\/s12891-021-04626-6","article-title":"Preoperative prognostic nutritional index is useful factor for predicting postoperative delirium after primary total joint arthroplasty","volume":"22","author":"Chen","year":"","journal-title":"BMC Musculoskelet. Disord."},{"key":"B8","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.genhosppsych.2017.03.008","article-title":"Prevalence and risk factors for postoperative delirium in total joint arthroplasty patients: a prospective study","volume":"46","author":"Chen","year":"2017","journal-title":"Gen. Hosp. Psychiat."},{"key":"B9","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1016\/j.archger.2015.01.021","article-title":"Risk factors of delirium in patients undergoing total knee arthroplasty","volume":"60","author":"Chung","year":"2015","journal-title":"Arch. Gerontol. Geriat."},{"key":"B10","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1093\/ageing\/afx042","article-title":"Observational cohort study examining apolipoprotein E status and preoperative neuropsychological performance as predictors of post-operative delirium in an older elective arthroplasty population","volume":"46","author":"Cunningham","year":"2017","journal-title":"Age Ageing."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1097\/SLA.0000000000002684","article-title":"CSF Beta-amyloid 1-42 concentration predicts delirium following elective arthroplasty surgery in an observational cohort study","volume":"269","author":"Cunningham","year":"2019","journal-title":"Ann. Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1097\/ALN.0b013e31824b94fc","article-title":"Obstructive sleep apnea and incidence of postoperative delirium after elective knee replacement in the nondemented elderly","volume":"116","author":"Flink","year":"2012","journal-title":"Anesthesiology."},{"key":"B13","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1159\/000056226","article-title":"Depression or hypoactive delirium? A report of ciprofloxacin-induced mental disorder in a patient with chronic obstructive pulmonary disease","volume":"70","author":"Grassi","year":"2001","journal-title":"Psychother. Psychosom"},{"key":"B14","doi-asserted-by":"publisher","first-page":"196","DOI":"10.3109\/00952990.2015.1130711","article-title":"Symptom profile of alcohol withdrawal delirium: factor analysis of Delirium Rating Scale-Revised-98 version","volume":"42","author":"Grover","year":"2016","journal-title":"Am. J. Drug Alcohol. Abuse."},{"key":"B15","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1097\/ALN.0000000000001660","article-title":"A systematic review and meta-analysis examining the impact of incident postoperative delirium on mortality","volume":"127","author":"Hamilton","year":"2017","journal-title":"Anesthesiology."},{"key":"B16","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1186\/s12888-020-02908-2","article-title":"Association between increased neutrophil-to-lymphocyte ratio and postoperative delirium in elderly patients with total hip arthroplasty for hip fracture","volume":"20","author":"He","year":"2020","journal-title":"BMC Psychiatry."},{"key":"B17","doi-asserted-by":"publisher","first-page":"81","DOI":"10.17305\/bjbms.2018.3653","article-title":"Delirium following total joint replacement surgery","volume":"19","author":"Huang","year":"2019","journal-title":"Bosn. J. Basic Med. Sci."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1213\/ANE.0b013e318211501b","article-title":"Cognitive and functional predictors and sequelae of postoperative delirium in elderly patients undergoing elective joint arthroplasty","volume":"112","author":"Jankowski","year":"2011","journal-title":"Anesth. Analg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1111\/ggi.14381","article-title":"Albumin\/fibrinogen ratio, an independent risk factor for postoperative delirium after total joint arthroplasty","volume":"22","author":"Jiang","year":"2022","journal-title":"Geriatr. Gerontol. Int."},{"key":"B20","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1007\/s12630-009-9148-0","article-title":"Delirium following vascular surgery: increased incidence with preoperative beta-blocker administration","volume":"56","author":"Katznelson","year":"2009","journal-title":"Can. J. Anaesth."},{"key":"B21","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1186\/s12891-020-03206-4","article-title":"Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty","volume":"21","author":"Kijima","year":"2020","journal-title":"BMC Musculoskelet. Disord."},{"key":"B22","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/1471-2253-12-4","article-title":"Does using a femoral nerve block for total knee replacement decrease postoperative delirium?","volume":"12","author":"Kinjo","year":"2012","journal-title":"BMC Anesthesiol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1111\/iwj.12640","article-title":"Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis","volume":"14","author":"Kong","year":"2017","journal-title":"Int. Wound J."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1392","DOI":"10.1097\/ALN.0b013e318272d884","article-title":"Postoperative obstructive sleep apnea and delirium?","volume":"117","author":"Krenk","year":"2012","journal-title":"Anesthesiology."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1562","DOI":"10.1097\/CCM.0000000000002558","article-title":"Benzodiazepines and delirium in the young and old: truth be told or still not sold?","volume":"45","author":"Kudchadkar","year":"2017","journal-title":"Crit. Care Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"340","DOI":"10.4306\/pi.2011.8.4.340","article-title":"Early assessment of delirium in elderly patients after hip surgery","volume":"8","author":"Lee","year":"2011","journal-title":"Psychiatry Investig."},{"key":"B27","doi-asserted-by":"publisher","first-page":"870317","DOI":"10.3389\/fpsyt.2022.870317","article-title":"Potential value of serum lipid in the identication of postoperative delirium undergoing knee\/hip arthroplasty: the perioperative neurocognitive disorder and biomarker lifestyle study","volume":"13","author":"Lin","year":"2022","journal-title":"Front Psychiatry."},{"key":"B28","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/1471-2288-14-45","article-title":"Newcastle-Ottawa scale: comparing reviewers' to authors' assessments","volume":"14","author":"Lo","year":"2014","journal-title":"BMC Med. Res. Methodol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1016\/j.jagp.2013.09.005","article-title":"Neuropathogenesis of delirium: review of current etiologic theories and common pathways","volume":"21","author":"Maldonado","year":"2013","journal-title":"Am. J. Geriatr. Psychiatry."},{"key":"B30","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1136\/rapm-2019-100700","article-title":"Risk factors for postoperative delirium in patients undergoing lower extremity joint arthroplasty: a retrospective population-based cohort study","volume":"44","author":"Memtsoudis","year":"2019","journal-title":"Reg. Anesth. Pain Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/s11325-013-0846-z","article-title":"Obstructive sleep apnea and delirium: exploring possible mechanisms","volume":"18","author":"Mirrakhimov","year":"2014","journal-title":"Sleep Breath."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1486","DOI":"10.1097\/CCM.0000000000003194","article-title":"Benzodiazepines and development of delirium in critically ill children: estimating the causal effect","volume":"46","author":"Mody","year":"2018","journal-title":"Crit. Care Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"256","DOI":"10.2174\/15672026113109990004","article-title":"Alcoholism and its effects on the central nervous system","volume":"10","author":"Mukherjee","year":"2013","journal-title":"Curr. Neurovasc. Res."},{"key":"B34","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1016\/j.arth.2013.06.004","article-title":"Pharmacologic risk factors for post-operative delirium in total joint arthroplasty patients: a case-control study","volume":"29","author":"Nandi","year":"2014","journal-title":"J. Arthroplasty."},{"key":"B35","doi-asserted-by":"publisher","first-page":"4","DOI":"10.4097\/kja.d.18.00073.1","article-title":"Postoperative delirium","volume":"72","author":"Oh","year":"2019","journal-title":"Kor. J. Anesthesiol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"2601","DOI":"10.1016\/j.arth.2019.06.042","article-title":"Preoperative C-reactive protein\/albumin ratio, a risk factor for postoperative delirium in elderly patients after total joint arthroplasty","volume":"34","author":"Peng","year":"2019","journal-title":"J Arthroplasty."},{"key":"B37","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1097\/AJP.0000000000000528","article-title":"The role of preoperative radiological severity, sensory testing, and temporal summation on chronic postoperative pain following total knee arthroplasty","volume":"34","author":"Petersen","year":"2018","journal-title":"Clin. J. Pain."},{"key":"B38","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1111\/aas.12932","article-title":"Delirium after fast-track hip and knee arthroplasty - a cohort study of 6331 elderly patients","volume":"61","author":"Petersen","year":"2017","journal-title":"Acta Anaesthesiol. Scand."},{"key":"B39","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1159\/000117574","article-title":"Usefulness of the short IQCODE for predicting postoperative delirium in elderly patients undergoing hip and knee replacement surgery","volume":"54","author":"Priner","year":"2008","journal-title":"Gerontology."},{"key":"B40","doi-asserted-by":"publisher","first-page":"386","DOI":"10.2174\/1381612826666191227153150","article-title":"Postoperative serum albumin decrease independently predicts delirium in elderly subjects after total joint arthroplasty","volume":"26","author":"Qi","year":"2020","journal-title":"Curr. Pharm. Des."},{"key":"B41","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1177\/2151458516641162","article-title":"Review of postoperative delirium in geriatric patients undergoing hip surgery","volume":"7","author":"Rizk","year":"2016","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"B42","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1016\/j.anclin.2015.05.007","article-title":"Postoperative delirium in the geriatric patient","volume":"33","author":"Schenning","year":"2015","journal-title":"Anesthesiol. Clin."},{"key":"B43","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1097\/BPO.0b013e31825fa7f2","article-title":"Total hip arthroplasty, hip osteoarthritis, total knee arthroplasty, and knee osteoarthritis in patients with developmental dysplasia of the hip and their family members: a kinship analysis report","volume":"32","author":"Schiffern","year":"2012","journal-title":"J. Pediatr. Orthop."},{"key":"B44","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1093\/ageing\/afl005","article-title":"Occurrence and outcome of delirium in medical in-patients: a systematic literature review","volume":"35","author":"Siddiqi","year":"2006","journal-title":"Age Ageing."},{"key":"B45","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/j.redar.2016.07.009","article-title":"Delirio postoperatorio en pacientes con historial de abuso de alcohol","volume":"64","author":"Sousa","year":"2017","journal-title":"Rev. Esp. Anestesiol. Reanim."},{"key":"B46","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1177\/1751143718787748","article-title":"The influence of alcohol abuse on agitation, delirium and sedative requirements of patients admitted to a general intensive care unit","volume":"20","author":"Stewart","year":"2019","journal-title":"J. Intensive Care Soc."},{"key":"B47","doi-asserted-by":"publisher","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group","volume":"283","author":"Stroup","year":"2000","journal-title":"JAMA."},{"key":"B48","doi-asserted-by":"publisher","first-page":"R77","DOI":"10.1186\/cc7892","article-title":"Risk factors for delirium in intensive care patients: a prospective cohort study","volume":"13","author":"Van Rompaey","year":"2009","journal-title":"Crit. Care."},{"key":"B49","doi-asserted-by":"publisher","first-page":"772795","DOI":"10.3389\/fnagi.2021.772795","article-title":"Potential value of cerebrospinal fluid progranulin in the identification of postoperative delirium in geriatrics patients undergoing knee replacement: the perioperative neurocognitive disorder and biomarker lifestylE study","volume":"13","author":"Wang","year":"2022","journal-title":"Front. Aging Neurosci."},{"key":"B50","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1186\/s12888-016-1130-0","article-title":"Electrolyte disorders and aging: risk factors for delirium in patients undergoing orthopedic surgeries","volume":"16","author":"Wang","year":"2016","journal-title":"BMC Psychiatry."},{"key":"B51","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1016\/j.bja.2017.12.046","article-title":"Postoperative delirium in total knee and hip arthroplasty patients: a study of perioperative modifiable risk factors","volume":"120","author":"Weinstein","year":"2018","journal-title":"Br. J. Anaesth."},{"key":"B52","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1080\/13607863.2016.1235680","article-title":"Delirium and mental health history as predictors of aggression in individuals with dementia in inpatient settings","volume":"22","author":"Wharton","year":"2018","journal-title":"Aging Ment. Health."},{"key":"B53","doi-asserted-by":"publisher","first-page":"20736","DOI":"10.1038\/srep20736","article-title":"Association between serum IGF-I levels and postoperative delirium in elderly subjects undergoing elective knee arthroplasty","volume":"6","author":"Yen","year":"2016","journal-title":"Sci. Rep."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2022.993136\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T10:32:21Z","timestamp":1664533941000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2022.993136\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,30]]},"references-count":53,"alternative-id":["10.3389\/fpsyg.2022.993136"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2022.993136","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,30]]},"article-number":"993136"}}