Preoperative prognostic factors associated with postoperative delirium in older people undergoing surgery: protocol for a systematic review and individual patient data meta-analysis

Buchan, Tayler A; Sadeghirad, Behnam; Schmutz, Nayeli; Goettel, Nicolai; Foroutan, Farid; Couban, Rachel; Mbuagbaw, Lawrence; Dodsworth, Benjamin T

doi:10.1186/s13643-020-01518-z

Cited by 6 publications

(8 citation statements)

References 41 publications

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“…An experienced librarian refined the searches for individual databases. Our search strategy is available in our published protocol …”

Section: Methodsmentioning

confidence: 99%

“…Details of our eligibility criteria and study selection process are provided in our published protocol. 22 In brief, we included studies that (1) enrolled adults (>16 years) undergoing noncardiac surgery, (2) assessed perioperative factors associated with delirium, and (3) assessed delirium (up to 10 days after surgery) using the Diagnostic and Statistical Manual of Mental Disorders (Third Edition),…”

Section: Study Selectionmentioning

confidence: 99%

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Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery

Sadeghirad,

Dodsworth,

Schmutz Gelsomino

et al. 2023

JAMA Netw Open

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ImportancePostoperative delirium (POD) is a common and serious complication after surgery. Various predisposing factors are associated with POD, but their magnitude and importance using an individual patient data (IPD) meta-analysis have not been assessed.ObjectiveTo identify perioperative factors associated with POD and assess their relative prognostic value among adults undergoing noncardiac surgery.Data SourcesMEDLINE, EMBASE, and CINAHL from inception to May 2020.Study SelectionStudies were included that (1) enrolled adult patients undergoing noncardiac surgery, (2) assessed perioperative risk factors for POD, and (3) measured the incidence of delirium (measured using a validated approach). Data were analyzed in 2020.Data Extraction and SynthesisIndividual patient data were pooled from 21 studies and 1-stage meta-analysis was performed using multilevel mixed-effects logistic regression after a multivariable imputation via chained equations model to impute missing data.Main Outcomes and MeasuresThe end point of interest was POD diagnosed up to 10 days after a procedure. A wide range of perioperative risk factors was considered as potentially associated with POD.ResultsA total of 192 studies met the eligibility criteria, and IPD were acquired from 21 studies that enrolled 8382 patients. Almost 1 in 5 patients developed POD (18%), and an increased risk of POD was associated with American Society of Anesthesiologists (ASA) status 4 (odds ratio [OR], 2.43; 95% CI, 1.42-4.14), older age (OR for 65-85 years, 2.67; 95% CI, 2.16-3.29; OR for &gt;85 years, 6.24; 95% CI, 4.65-8.37), low body mass index (OR for body mass index &lt;18.5, 2.25; 95% CI, 1.64-3.09), history of delirium (OR, 3.9; 95% CI, 2.69-5.66), preoperative cognitive impairment (OR, 3.99; 95% CI, 2.94-5.43), and preoperative C-reactive protein levels (OR for 5-10 mg/dL, 2.35; 95% CI, 1.59-3.50; OR for &gt;10 mg/dL, 3.56; 95% CI, 2.46-5.17). Completing a college degree or higher was associated with a decreased likelihood of developing POD (OR 0.45; 95% CI, 0.28-0.72).Conclusions and RelevanceIn this systematic review and meta-analysis of individual patient data, several important factors associated with POD were found that may help identify patients at high risk and may have utility in clinical practice to inform patients and caregivers about the expected risk of developing delirium after surgery. Future studies should explore strategies to reduce delirium after surgery.

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“…An experienced librarian refined the searches for individual databases. Our search strategy is available in our published protocol …”

Section: Methodsmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery

Sadeghirad,

Dodsworth,

Schmutz Gelsomino

et al. 2023

JAMA Netw Open

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“…A major obstacle to the creation of a suitable algorithm is the underdiagnosis of delirium; previous studies have shown that up to two-thirds of cases are missed by healthcare professionals caring for the patient [ 13–16 ], thereby making conventional hospital records unreliable for the creation of a risk prediction model. Hence, a systematic review and meta-analysis of risk factor studies with an outcome of POD (see protocol [ 17 ]) was conducted. Included studies assessed risk factors preoperatively and systematically assessed all patients for POD for at least the first 2 days post-surgery using a validated delirium diagnosis tool.…”

Section: Methodsmentioning

confidence: 99%

Development and validation of an international preoperative risk assessment model for postoperative delirium

Dodsworth,

Reeve,

Falco

et al. 2023

Age and Ageing

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Background Postoperative delirium (POD) is a frequent complication in older adults, characterised by disturbances in attention, awareness and cognition, and associated with prolonged hospitalisation, poor functional recovery, cognitive decline, long-term dementia and increased mortality. Early identification of patients at risk of POD can considerably aid prevention. Methods We have developed a preoperative POD risk prediction algorithm using data from eight studies identified during a systematic review and providing individual-level data. Ten-fold cross-validation was used for predictor selection and internal validation of the final penalised logistic regression model. The external validation used data from university hospitals in Switzerland and Germany. Results Development included 2,250 surgical (excluding cardiac and intracranial) patients 60 years of age or older, 444 of whom developed POD. The final model included age, body mass index, American Society of Anaesthesiologists (ASA) score, history of delirium, cognitive impairment, medications, optional C-reactive protein (CRP), surgical risk and whether the operation is a laparotomy/thoracotomy. At internal validation, the algorithm had an AUC of 0.80 (95% CI: 0.77–0.82) with CRP and 0.79 (95% CI: 0.77–0.82) without CRP. The external validation consisted of 359 patients, 87 of whom developed POD. The external validation yielded an AUC of 0.74 (95% CI: 0.68–0.80). Conclusions The algorithm is named PIPRA (Pre-Interventional Preventive Risk Assessment), has European conformity (ce) certification, is available at http://pipra.ch/ and is accepted for clinical use. It can be used to optimise patient care and prioritise interventions for vulnerable patients and presents an effective way to implement POD prevention strategies in clinical practice.

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“…As a common postoperative complication, all age groups of patients can affect by this complication, but this postoperative complication is highly affected geriatric patients, with an incidence rate ranging from 5% to 52% depending on the risk to patients and surgical procedure of an elderly population which often began in the post-anesthesia care unit and continuous up to 5 days post-surgical procedure. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

“…The most common complication of geriatric surgery is POD with an overall incidence rate of 5% to 52% of the geriatric surgical patient. 3 , 4 , 10 According to a recent review study, the prevalence of mortality from patients with POD was 25%. 12 This indicates that POD has a huge burden on the health-care system and the patients.…”

Section: Introductionmentioning

confidence: 99%

Evidence-Based Guideline on Management of Postoperative Delirium in Older People for Low Resource Setting: Systematic Review Article

Mossie¹,

Regasa²,

Neme³

et al. 2022

IJGM

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Background Postoperative delirium is the highest prevalence and life-threatening complication following geriatric surgery. The overall incidence rate varies from 5% to 52% of hospitalized surgical patients based on the type of surgery that often began in the postanesthesia care unit and continues up to 5 days post-surgery. Postoperative delirium manifests as a hypoactive, hyperactive and mixed subtype. The mechanism of delirium development is not clear, but it is accepted that delirium is a result of the patient’s underlying vulnerabilities or risk factors combined with an outside stressor such as infection or surgery. Objective To develop evidence-based recommendations for the prevention, diagnosis, and treatment of postoperative delirium. Methods Literature was searched from PubMed, CINAH, Google Scholar, and Cochrane databases that are published from 2010 to 2021 by formulating inclusion and exclusion criteria. Filtering was made depending on methodological quality, outcome, and data on population. Finally, 11 meta-analysis, 11 systematic reviews, 7 interventional studies, 11 observational studies, and recommendations of the previous clinical practice guideline developed by the American and European are included in this review. Results A total of 43 studies were considered in this evaluation. The development of this guideline was based on nine studies on risk stratification for postoperative delirium, eighteen studies on risk minimization and prevention for postoperative delirium, five studies on diagnosis for postoperative delirium, and eleven studies on treatments for postoperative delirium. Conclusion Postoperative delirium management can be categorized into risk assessment, risk minimization, early diagnosis, and treatment. Early diagnosis is critical to trigger focused and effective treatment. Non-pharmacological interventions are the first-line management for both hypoactive and hyperactive postoperative with considering contributory factors and underlying causes. Antipsychotics should only be used for hyperactive delirium individuals who try to harm themselves. Current evidence suggested that dexmedetomidine can be used as a treatment option for postoperative delirium.

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Preoperative prognostic factors associated with postoperative delirium in older people undergoing surgery: protocol for a systematic review and individual patient data meta-analysis

Cited by 6 publications

References 41 publications

Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery

Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery

Development and validation of an international preoperative risk assessment model for postoperative delirium

Evidence-Based Guideline on Management of Postoperative Delirium in Older People for Low Resource Setting: Systematic Review Article

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