The Association Between Preoperative Frailty and Postoperative Delirium: A Systematic Review and Meta-analysis

Liu, Changyuan; Gong, Ning; Liu, Wei

doi:10.1016/j.jopan.2020.12.006

Cited by 7 publications

(7 citation statements)

References 64 publications

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“…With respect to the association with delirium our results are also consistent with the one reported in a recent metaanalysis including 11 studies using different definitions of frailty with an overall accumulative adjusted OR of 2.45 [95% CI 1.58, 3.81] in frail patients undergoing elective surgery [ 10 ]. Another metaanalysis including 9 studies representing 794 patients undergoing surgery showed an adjusted OR of 2.14 [95% CI 1.43, 3.19] [ 11 ].…”

Section: Discussionsupporting

confidence: 90%

“…The distribution of the FI in our population of older adults undergoing elective surgery is consistent with observations made in literature, with women having on average higher frailty indices than men [ 30 ]. Contrary, the observed prevalence of frailty based on a model of accumulation of deficits using a cut-off of 0.2 is markedly higher than the one reported in the literature as well as the one expected in community-dwelling older adults [ 10 ]. In this context available data on prevalence of frailty in patients undergoing elective surgery is mainly based on the phenotypic model of frailty, making a direct comparison impossible.…”

Section: Discussionmentioning

confidence: 94%

“…So far, the association between frailty and delirium has been evaluated mostly in patients admitted to general medicine wards or in mixed populations [ 13 , 14 ]. Literature on patients admitted only to surgical departments is scarce, based mainly on small study populations undergoing one type of surgery, with only few of them using the FI as a construct for the preoperative evaluation of this condition [ 10 , 11 ]. In this regard the current developments with the use of electronical medical records could allow the preoperative estimation of a FI in different settings, supporting the prediction of delirium risk as well as the implementation of tailored delirium prevention management programs.…”

Section: Introductionmentioning

confidence: 99%

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Frailty index and its association with the onset of postoperative delirium in older adults undergoing elective surgery

et al. 2023

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Background The association of frailty based on the accumulation of deficits with postoperative delirium (POD) has been poorly examined. We aimed to analyze this association in older patients undergoing elective surgery. Methods Preoperative data was used to build a 30-item frailty index (FI) for participants of the PAWEL-study. Delirium was defined by a combination of I-CAM and chart review. Using logistic regressions models we analysed the association between frailty and POD adjusting for age, sex, smoking, alcohol consumption, education and type of surgery. Results Among 701 participants (mean age 77.1, 52.4% male) median FI was 0.27 (Q1 0.20| Q3 0.34), with 528 (75.3%) frail participants (FI ≥ 0.2). Higher median FI were seen in orthopedic than cardiac surgery patients (0.28 versus 0.23), and in women (0.28 versus 0.25 in men). Frail participants showed a higher POD incidence proportion (25.4% versus 17.9% in non-frail). An increased odds for POD was observed in frail versus non-frail participants (OR 2.14 [95% CI 1.33, 3.44], c-statistic 0.71). A 0.1 increment of FI was associated with OR 1.57 [95% CI 1.30, 1.90] (c-statistic 0.72) for POD. No interaction with sex or type of surgery was detected. Adding timed-up-and-go-test and handgrip strength to the FI did not improve discrimination. Conclusion Our data showed a significant association between frailty defined through a 30-item FI and POD among older adults undergoing elective surgery. Adding functional measures to the FI did not improve discrimination. Hence, our preoperative 30-item FI can help to identify patients with increased odds for POD. Trial registration PAWEL and PAWEL-R (sub-) study were registered on the German Clinical Trials Register (number DRKS00013311 and DRKS00012797).

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Frailty index and its association with the onset of postoperative delirium in older adults undergoing elective surgery

et al. 2023

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“…For instance, the research of Burton et al [48] only focused on the risk factors of frailty in acute stroke, and they only include 14 papers. The paper of Gallo et al [49] only focused on the risk factors of frailty in plastic surgery, and the study of Liu et al [50] only focused on the preoperative and postoperative delirium. While the report of Hajek et al [51] only contained the personality factors, we also include the effects of concomitant diseases on weakness.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for frailty in older adults

Wang

2022

Medicine

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Aims: To clarify the risk factors for frailty to help doctors prevent diseases that cause weakness, through early interventions. Methods: We searched the PubMed, EMBASE, and Cochrane Library databases to identify all relevant studies using the items “frailty,” “weak,” “risk factors,” and “predictive factors” and compared their results. The aging population (≥65 years old) was divided into 2 groups, a “frailty group” and a “robust control group,” and then the characteristics, lifestyles, and comorbidities were compared. Results: We compared the influence of baseline and concomitant diseases on frailty in the elderly respectively, and the analysis of the influence of baseline on frailty found that increasing age, lower weight, female sex, living alone, low levels of exercise, polypharmacy, higher education level, smoking, drinking, malnutrition, and lower vitamin D levels were associated with aging individuals being more likely to experience frailty. The data about concomitant diseases had shown that diabetes, hearing dysfunction, cognitive impairment, poor sleep, a history of falls, pain, and depression can increase the risk of frailty among the elderly population. Conclusion: Characteristics, comorbidities, and lifestyle factors can impact the occurrence of frailty, and relevant influencing factors should be considered.

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“…Other frailty scores that directly measure patient function or are designed for individual assessment have been shown to be associated with POD. 13,29 Consultation for delirium was requested in 24% of POD cases. Pharmacists were consulted the most often, but less than a third recommended any medication changes.…”

Section: Discussionmentioning

confidence: 99%

Clinical Predictors and Outcomes Associated with Postoperative Delirium Following Infrainguinal Bypass Surgery

Gutierrez

Matthay

Smith

et al. 2022

Annals of Vascular Surgery

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The Association Between Preoperative Frailty and Postoperative Delirium: A Systematic Review and Meta-analysis

Cited by 7 publications

References 64 publications

Frailty index and its association with the onset of postoperative delirium in older adults undergoing elective surgery

Frailty index and its association with the onset of postoperative delirium in older adults undergoing elective surgery

Risk factors for frailty in older adults

Clinical Predictors and Outcomes Associated with Postoperative Delirium Following Infrainguinal Bypass Surgery

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