Factors associated with postoperative delirium in patients undergoing oral and maxillofacial surgery: a meta-analysis of observational study

Background Postoperative delirium (POD) is a common and serious complication, particularly prevalent among patients undergoing oral and maxillofacial surgery (OMFS). Although studies have explored risk factors for POD, a systematic assessment for OMFS patients remains lacking. This study aimed to identify and synthesize factors associated with POD in patients undergoing OMFS. However, the currently available evidence appears to be derived mainly from major oncologic and reconstructive OMFS populations. Methods The literature search was conducted from the establishment of the database to December 10, 2025, covering PubMed, Embase, Cochrane Library, and Web of Science. All studies involving POD in patients undergoing OMFS were included in the analysis. The quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). Data analysis was performed using Stata 15 software, employing a random-effects model for meta-analysis of potential risk factors. Results A total of seven studies involving 2,398 patients were included. The meta-analysis showed that age >65 years [OR = 1.63, 95% CI (1.15, 2.31)], male sex [OR = 1.90, 95% CI (1.17, 3.09)], alcohol consumption [OR = 3.43, 95% CI (2.09, 5.66)], smoking [OR = 2.34, 95% CI (1.19, 4.59)], and insomnia [OR = 2.27, 95% CI (1.24, 4.19)] were associated with POD in patients undergoing OMFS. Conclusion This study suggests that age >65 years, male sex, alcohol consumption, smoking, and insomnia may be associated with POD in patients undergoing OMFS. However, the available evidence is derived predominantly from major oral cancer and reconstructive surgery populations, and all included studies were observational. Therefore, these findings should be interpreted as associations rather than causal risk factors, and their applicability to the broader spectrum of OMFS procedures remains uncertain. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251267779