Delirium in neurosurgery: a systematic review and meta-analysis

Abstract

Delirium is a frequent occurring complication in surgical patients. Nevertheless, a scientific work-up of the clinical relevance of delirium after intracranial surgery is lacking. We conducted a systematic review (CRD42020166656) to evaluate the current diagnostic work-up, incidence, risk factors and health outcomes of delirium in this population. Five databases (Embase, Medline, Web of Science, PsycINFO, Cochrane Central) were searched from inception through March 31st, 2021. Twenty-four studies (5589 patients) were included for qualitative analysis and twenty-one studies for quantitative analysis (5083 patients). Validated delirium screening tools were used in 70% of the studies, consisting of the Confusion Assessment Method (intensive care unit) (45%), Delirium Observation Screening Scale (5%), Intensive Care Delirium Screening Checklist (10%), Neelon and Champagne Confusion Scale (5%) and Nursing Delirium Screening Scale (5%). Incidence of post-operative delirium after intracranial surgery was 19%, ranging from 12 to 26% caused by variation in clinical features and delirium assessment methods. Meta-regression for age and gender did not show a correlation with delirium. We present an overview of risk factors and health outcomes associated with the onset of delirium. Our review highlights the need of future research on delirium in neurosurgery, which should focus on optimizing diagnosis and assessing prognostic significance and management.

Intraoperative infusion of dexmedetomidine for prevention of postoperative delirium in elderly patients undergoing craniotomy: a protocol of randomised clinical trial

“…The incidence of POD is about 15%–20% in patients undergoing neurosurgery, 1 and a number of studies have shown that age is the independent risk factors of POD in neurosurgery patients. 19 Therefore, the incidence of POD might be higher in elderly neurosurgery patients.…”

“…The incidence of postoperative delirium (POD) varies significantly among different surgical types. Recently, a systematic review conducted for 18 studies showed the incidence of POD was 19% in neurosurgery patients, 1 and over 40% occurred after deep brain stimulation implantation surgery. 2 POD significantly prolongs the length of hospital stay, 3 4 decreases survival rate 5 and is associated with long-term postoperative cognitive dysfunction.…”

“… 7–9 Several studies have demonstrated advanced age significantly increased the incidence of POD in neurosurgical patients. 1 3 5 10 11 Additionally, advanced age could deteriorate the complication (eg, sleep apnoea, heart failure and diabetes). 12 Frailty 13 and malnutrition 14 further indirectly increased the risk of delirium.…”

Postoperative Delirium in Neurosurgical Patients: Recent Insights into the Pathogenesis

“…POD was found to occur in 7% of glioblastoma patients and was associated with longer hospital stays, a lower probability of discharge home, and decreased survival [ 129 ]. A meta-analysis of 5589 patients revealed that the incidence of POD after intracranial surgery was 19%, ranging from 12% to 26%, due to variations in clinical characteristics and delirium assessment methods [ 11 ].…”

“…Among those patients undergoing intracranial surgery, 4.2% had serious POD, which is directly associated with impaired neurological function and extended rehabilitation [ 10 ]. A meta-analysis involving 5589 patients revealed that the incidence of POD after intracranial surgery ranges from 12% to 26% due to variations in clinical characteristics and delirium assessment methods [ 11 ].…”