Risk factors of delirium after gastrointestinal surgery: A meta‐analysis

Abstract

Background Postoperative delirium is one of the common complications after any major surgery such as gastrointestinal surgery. And it is related to increased mortality and morbidity and other serious surgical outcomes. Aims This study aims to identify risk factors for postoperative delirium in patients undergoing gastrointestinal surgery. Materials and Methods Relevant studies published before August 2021 were searched on Pubmed, Embase and Medline. The risk of bias of included studies was assessed by Newcastle–Ottawa Scale (NOS). A random‐effects model of DerSimonian‐Laird was used to synthesise the overall ORs or RRs for all risk factors. MOOSE checklist was used to review this manuscript. Results A total of 21 studies including 6165 patients were finally included for quantitative analysis. The pooled incidence of postoperative delirium is 11% (95% CI: 9%‐15%). 16 risk factors were identified, in which age, sex, alcohol consumption, cerebrovascular diseases, cardiovascular diseases, use of sleeping pills, history of delirium, preoperative C‐reactive protein (CRP) levels, operation time, blood loss and perioperative blood transfusion were statistically significant while smoking, American Society of Anesthesiologists (ASA) score, performance status, diabetes and operation approach were insignificant. Discussion This meta‐analysis may provide tips for nursing staff and surgeons to design and implement prevention programmes to reduce the incidence of postoperative delirium. Conclusion Potential risk factors of delirium after gastrointestinal surgery are age, sex, alcohol consumption, cerebrovascular diseases, cardiovascular diseases, use of sleeping pills, history of delirium, preoperative CRP levels, operation time, blood loss and blood transfusion.

Associated factors for postoperative delirium following major abdominal surgery: A systematic review and meta‐analysis

“…In addition, as previously mentioned, diabetes mellitus was an independent risk factor for POD 37,38 . Conversely, our meta‐analysis showed that diabetes mellitus was not related to the occurrence of POD, which was consistent with a prior meta‐analysis 14 . In addition, some cardiovascular and cerebrovascular diseases, such as hypertension and a history of delirium, have been reported to have a significant relationship with POD according to previous studies 11,37 .…”

“…37,38 Conversely, our meta-analysis showed that diabetes mellitus was not related to the occurrence of POD, which was consistent with a prior meta-analysis. 14 In addition, some cardiovascular and cerebrovascular diseases, such as hypertension and a history of delirium, have been reported to have a significant relationship with POD according to previous studies. 11,37 However, since we only extracted one study on these related factors, a meta-analysis was not conducted.…”

“…43 Similar to our study, two meta-analyses illustrated that the level of serum albumin in the delirium group was lower than that in the non-delirium group following gastrointestinal surgery. 11,14 Therefore, an early preoperative understanding of serum albumin levels and corresponding strategy implementation will LIU ET AL.…”

“…Major abdominal surgery, common types of surgery in elderly patients, include gastrointestinal surgery, liver surgery, and abdominal aortic aneurysms, which are associated with various postoperative complications, including POD. Previous meta‐analyses have suggested some common risk factors for POD in gastrointestinal surgery, such as age, sex, alcohol consumption, and cerebrovascular diseases and etc 13,14 . However, the surgical type included in these reviews was limited to gastrointestinal surgery.…”

“…Previous meta-analyses have suggested some common risk factors for POD in gastrointestinal surgery, such as age, sex, alcohol consumption, and cerebrovascular diseases and etc. 13,14 However, the surgical type included in these reviews was limited to gastrointestinal surgery. To our knowledge, no systematic review or meta-analysis has summarized the risk factors for POD in patients undergoing major abdominal surgery.…”