Risk factors for postoperative delirium: An umbrella review of systematic reviews

Bramley, Paul; McArthur, Kaitlin; Blayney, Alexander; McCullagh, Iain J

doi:10.1016/j.ijsu.2021.106063

Cited by 94 publications

(64 citation statements)

References 35 publications

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“…The present study demonstrated the risk of postoperative blood transfusion for delirium. The possible reason is that anemia or blood loss is highly correlated with transfusion, which may cause reduced cerebral blood flow and impair tissue oxygenation capacity, thereby causing delirium ( 34 , 35 ). In addition, blood transfusion itself may cause POD since it may result in dysregulation of cytokines and further amplify the systemic inflammatory response ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict postoperative delirium in type B aortic dissection patients underwent thoracic endovascular aortic repair

Huang

Zhang

et al. 2022

Front. Surg.

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ObjectivePostoperative delirium (POD) is a common postoperative complication after cardiovascular surgery with adverse outcomes. No prediction tools are currently available for assessing POD in the type B aortic dissection (TBAD) population. The purposes of this study were to develop and validate a nomogram for predicting POD among TBAD patients who underwent thoracic endovascular aortic repair (TEVAR).MethodsThe retrospective cohort included 631 eligible TBAD patients who underwent TEVAR from January 2019 to July 2021. 434 patients included before 2021 were in the develop set; 197 others were in the independent validation set. Least absolute shrinkage and selection operator (LASSO) and logistic regression were applied to identify the most useful predictive variables for constructing the nomogram. Discrimination and the agreement of the model was assessed with the area under the receiver operating characteristic curve (AUC), Brier score and the Hosmer-Lemeshow goodness-of-fit test. The results were validated using a bootstrap resampling and the validation set.ResultsThe incidence rate of POD observed in the development and validation cohort were 15.0% and 14.2%, respectively. Seven independent risk factors, including age ≥60 years, syncope or coma, postoperative blood transfusion, atelectasis, estimated glomerular filtration rate (eGFR) <80 ml/min/1.73 m2, albumin <30 g/L, and neutrophil to lymphocyte ratio, were included in the nomogram. The model showed a good discrimination with an AUC of 0.819 (95% CI, 0.762–0.876) in the developed set, and adjusted to 0.797 (95% CI, 0.735–0.849) and 0.791 (95% CI, 0.700–0.881) in the internal validation set and the external validation, respectively. Favorable calibration of the nomogram was confirmed in both the development and validation cohorts.ConclusionThe nomogram based on seven readily available predictors has sufficient validity to identify POD risk in this population. This tool may facilitate targeted initiation of POD preventive intervention for healthcare providers.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict postoperative delirium in type B aortic dissection patients underwent thoracic endovascular aortic repair

Huang

Zhang

et al. 2022

Front. Surg.

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“…Despite several available tools for the assessment of cognitive functions, no comprehensive tools have been developed to include all types of risk assessments in order to predict the emergence of delirium. Furthermore, studies have continued to stress the inadequacies of the incomplete information and practice reported in the literature for the use by health personnel working in the field and for the early recognition of delirium [5,15]. In addition to the MMSE examined in this study, several major dementia screening and rating scales are in current use, including IADL, Blessed Dementia Rating Scale-Consortium to Establish a Registry for Alzheimer's Disease (BDRS-CERAD), physical selfmaintenance scale (PSMS), and the Katz index of independence in activities of daily living.…”

Section: Discussionmentioning

confidence: 99%

“…Cognitive and functional losses, which are the long-term effects of delirium, may continue further after the hospital discharge leading to rehospitalization [13,14]. Affecting wellbeing unfavorably, the clinical symptoms and risk factors of delirium have not yet been fully recognized and are often not identified by healthcare professionals as they can be misdiagnosed as other types of cognitive disorders [5,15]. The aim of this study was to systematically review the national and international studies that have investigated the risk factors leading to delirium in geriatric patients after orthopaedic surgery and to perform a meta-analysis using the data reported by those studies.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for the development of delirium in elderly patients undergoing orthopaedic surgery: A systematic review and metaanalysis

Durmayüksel¹,

Çınar²,

Güven³

et al. 2021

J Clin Invest Surg.

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Objective. Delirium is a temporary neuropsychiatric syndrome characterized by fluctuations in cognition and attention. Delirium is one of the most common complications seen in old individuals after orthopaedic surgery. With a high incidence, the clinical picture of delirium increases the length of hospital stay and increases healthcare-related costs. This study has aimed to systematically review the national and international studies that investigated the risk factors leading to delirium in geriatric patients after orthopaedic surgery and to perform a meta-analysis using the data reported by those studies. Materials and Methods. A preliminary literature review was performed on six databases. The following English keyword combinations were used including 'Orthopaedic Surgery', 'Geriatrics', 'Elderly', and 'Delirium'. The results of trials were evaluated with random or fixed effect model according to the heterogeneity. Statistical evaluation was performed by using Comprehensive Meta Analysis version 3 programme. Results. The total sample size of the studies included in the analysis was 892. In geriatric patients; who had undergone orthopaedic surgery and developed delirium, the random-effects model revealed a high-level, in the positive direction, and statistically significant (p<0.05) overall effect size of 5.21 (CI; 1.33-20.33) for gender, 1.33 (CI; 0.58-2.06) for age, 11.30 (CI; 4.70-27.12 for polypharmacy, and a low-level, in the positive direction, and statistically significant (p<0.05) overall effect size of 0.12 (CI; 0.05-0.27) for mini-mental state examination as the risk factors leading to the development of delirium. Conclusions. Advanced age, female gender, polypharmacy, and a mini-mental state examination score of 17-23 are major risk factors for the development of delirium after orthopaedic surgery.

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“…Previous studies have shown a high incidence of POD in elderly patients (≥ 65 years old) with hip fracture and cardiac surgery [8][9][10], with major risk factors including advanced age, length of nursing home residence, prior cognitive impairment, psychiatric disorders, cerebrovascular disease, end-stage renal failure, low albumin (ALB), high American Society of Anesthesiologists (ASA) classification, and intraoperative blood transfusion [11,12].…”

Section: Introductionmentioning

confidence: 99%

Effect of tourniquet technique on postoperative delirium in elderly patients with total knee arthroplasty: a randomized single-blind controlled trial

Wei

Yuan

et al. 2022

BMC Anesthesiol

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Background The tourniquet technique is often used in total knee arthroplasty (TKA). However, its effect on postoperative delirium (POD) in elderly patients undergoing TKA is unknown. Methods This prospective randomized controlled trial assessed the eligibility of 245 elderly patients. A total of 197 patients who met the inclusion criteria were randomly divided into a tourniquet group (n = 98) and a non-tourniquet group (n = 99). The primary outcome was the incidence of POD within 72 h after surgery. The secondary outcome was the quality of rehabilitation, including inflammatory reaction, postoperative pain, hypoproteinemia and anemia. Results Of 245 patients, 184 patients completed this clinical trial, with 92 cases in each group. There were 14 patients (15.22%) with POD in the tourniquet group and 5 patients (5.43%) in the non-tourniquet group (95% CI 1.076 to 9.067, P = 0.029). The changes in white blood cell count (WBC), the proportion of neutrophils (NEUT%), c-reactive protein (CRP), interleukin-6 (IL-6) and middle patellar circumference in the tourniquet group were higher than those in the non-tourniquet group (P < 0.05). The visual analog scale (VAS) at rest and activity in the tourniquet group were higher than those in the non-tourniquet group (F = 170.102, P < 0.001 F = 75.391, P < 0.001). There were 41 (44.57%) patients with hypoproteinemia in the tourniquet group and 26 (28.26%) in the non-tourniquet group (95% CI 1.106 to 3.765, P = 0.022). Conclusion The application of the tourniquet technique in elderly patients with TKA procedures increased the incidence of POD. This may be attributed to the increased inflammatory reaction, severe postoperative pain and hypoproteinemia caused by the tourniquet technique. Trial registration Clinical trial registration number: ChiCTR2100045711. Full date of the first registration: 23/04/2021.

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Risk factors for postoperative delirium: An umbrella review of systematic reviews

Cited by 94 publications

References 35 publications

Development and validation of a nomogram to predict postoperative delirium in type B aortic dissection patients underwent thoracic endovascular aortic repair

Development and validation of a nomogram to predict postoperative delirium in type B aortic dissection patients underwent thoracic endovascular aortic repair

Risk factors for the development of delirium in elderly patients undergoing orthopaedic surgery: A systematic review and metaanalysis

Effect of tourniquet technique on postoperative delirium in elderly patients with total knee arthroplasty: a randomized single-blind controlled trial

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