The Utilization of Preoperative Steroids Safely Decreases the Risk of Postoperative Delirium in Geriatric Patients after Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

OBJECTIVES: Postoperative delirium is an acute neurocognitive complication that can have adverse effects on outcomes of geriatric patients after undergoing hip fracture surgery. The objective of this study was to examine the efficacy of preoperative steroids in preventing postoperative delirium after hip fracture surgery. METHODS: Data Sources: A systematic review and meta-analysis was performed using PubMed, SPORTDiscus, CINAHL, MEDLINE, and Web of Science from database inception until September 28th, 2023. Study Selection: Inclusion criteria were randomized controlled trials (RCTs) of patients who underwent surgical intervention for hip fracture, were examined for postoperative delirium, and utilized preoperative steroids. Data Extraction: Data included the risk of postoperative delirium, postoperative all-cause infection, and postoperative hyperglycemia. Articles were graded via the Cochrane Collaboration’s tool. Data Synthesis: Statistical analysis included a random-effects binary model with relative risk (RR), 95% confidence intervals (CI) along with a defined “number needed to treat” threshold (NNT). RESULTS: Four RCTs were included from 128 articles initially retrieved. Patients (n=416; average age: 82.2 ± 2.2 years old) underwent surgical intervention for hip fracture after receiving either preoperative steroids (n=209) or control interventions (n=207). There was a statistically significant decrease in the incidence of postoperative delirium among patients who received preoperative steroids (12.9%; 27 cases) as compared to patients who received control interventions (26.7%; 55 cases) after hip fracture surgery (p<0.001; RR: 0.84). The absolute risk difference was 13.8% and the NNT was 7.2 patients. There was no statistically significant difference in the risk of postoperative all-cause infection among patients who received preoperative steroids as compared to patients who received normal saline as placebo after hip fracture surgery (p=0.850; RR: 0.96). CONCLUSIONS: The utilization of preoperative steroids appears to decrease the risk of postoperative delirium after hip fracture surgery in elderly adults. Furthermore, this decreased risk of postoperative delirium was not associated with a significant increase in postoperative infection, indicating possible safety of preoperative steroid administration. LEVEL OF EVIDENCE: Level I. See Instructions for Authors for a complete description of levels of evidence.