Abstract
OBJECTIVE: To systematically evaluate the efficacy of perioperative drug injection in preventing postoperative delirium (POD) following hip fracture (HF) surgeries. METHODS: This research scheme was published on the PROSPERO platform (registration number: CRD42024602190). Databases searched included PubMed, Web of Science, Embase, and Cochrane. The search deadline was July 2024. Statistical analyses were conducted using StataSE15.0 software. Paired analysis and network meta-analysis were performed in R Studio, with included drugs ranked using the cumulative ranking probability plot area (SUCRA) for each outcome measure. The incidence, severity, and duration of delirium were analyzed using risk ratios (RR), weighted mean differences (WMD), and their corresponding 95% confidence intervals (CI). RESULTS: This meta-analysis included 13 studies: 9 RCTs and 4 cohort studies involving 2,291 patients with HF. The results indicated a significant reduction in the incidence of POD among patients who received perioperative drug injections, with a combined RR of 0.56 [95% CI (0.47, 0.67), P < 0.001]. There was also a significant reduction in the severity of delirium, with a combined WMD of -2.78 [95% CI (-4.38, -1.19), P = 0.01]. However, there were no significant differences in the duration of delirium or the incidence of adverse events, with combined values of [WMD = -1.81, 95% CI (-3.89, 0.27), P = 0.088] and [RR = 1.34, 95% CI (0.78, 2.32), P = 0.294], respectively. Network meta-analysis identified morphine as the most effective drug for preventing delirium, with a SUCRA value of 19.1%. CONCLUSION: In patients undergoing surgery for HF, perioperative drug injections significantly reduce the incidence and severity of postoperative delirium, with intrathecal morphine being the most effective option for prevention. These findings provide valuable insights for managing postoperative delirium prevention in HF patients. Further high-quality randomized controlled studies are needed to validate these results.