Association between postoperative delirium and adverse outcomes in older surgical patients: A systematic review and meta-analysis

To assess the incidence of postoperative delirium and its outcomes in older non-cardiac surgical patients. A systematic review and meta-analysis with multiple databases searched from inception to February 22, 2022. Postoperative assessments. Non-cardiac and non-neurological surgical patients aged ≥6...

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Vydané v:Journal of clinical anesthesia Ročník 90; s. 111221
Hlavní autori: Yan, Ellene, Veitch, Matthew, Saripella, Aparna, Alhamdah, Yasmin, Butris, Nina, Tang-Wai, David F., Tartaglia, Maria Carmela, Nagappa, Mahesh, Englesakis, Marina, He, David, Chung, Frances
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Elsevier Inc 01.11.2023
Elsevier Limited
Predmet:
Adverse outcomes
Aged
Anesthesia
Bias
Cognition & reasoning
Delirium
Delirium - epidemiology
Delirium - etiology
Delirium - prevention & control
Emergence Delirium
Geriatrics
Heart surgery
Hospitalization
Hospitals
Humans
Intensive care
Length of Stay
Meta-analysis
Mortality
Nursing
Observational studies
Older patients
Older people
Pain Medicine
Perioperative care
Postoperative complications
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Postoperative delirium
Postoperative period
Quantitative analysis
Surgery
Surgical outcomes
Systematic review
Adverse outcomes
Older patients
Postoperative delirium
Surgery
Postoperative complications
ISSN:0952-8180, 1873-4529, 1873-4529
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Popis
Shrnutí:To assess the incidence of postoperative delirium and its outcomes in older non-cardiac surgical patients. A systematic review and meta-analysis with multiple databases searched from inception to February 22, 2022. Postoperative assessments. Non-cardiac and non-neurological surgical patients aged ≥60 years with and without postoperative delirium. Included studies must report ≥1 postoperative outcome. Studies with a small sample size (N < 100 subjects) were excluded. Outcomes comprised the pooled incidence of postoperative delirium and its postoperative outcomes, including mortality, complications, unplanned intensive care unit admissions, length of stay, and non-home discharge. For dichotomous and continuous outcomes, OR and difference in means were computed, respectively, with a 95% CI. Fifty-four studies (20,988 patients, 31 elective studies, 23 emergency studies) were included. The pooled incidence of postoperative delirium was 19% (95% CI: 16%, 23%) after elective surgery and 32% (95% CI: 25%, 39%) after emergency surgery. In elective surgery, postoperative delirium was associated with increased mortality at 1-month (OR: 6.60; 95% CI: 1.58, 27.66), 6-month (OR: 5.69; 95% CI: 2.33, 13.88), and 1-year (OR: 2.87; 95% CI: 1.63, 5.06). The odds of postoperative complications, unplanned intensive care unit admissions, prolonged length of hospital stay, and non-home discharge were also higher in delirium cases. In emergency surgery, patients with postoperative delirium had greater odds of mortality at 1-month (OR: 3.56; 95% CI: 1.77, 7.15), 6-month (OR: 2.60; 95% CI: 1.88, 3.61), and 1-year (OR: 2.30; 95% CI: 1.77, 3.00). Postoperative delirium was associated with higher odds of mortality, postoperative complications, unplanned intensive care unit admissions, length of hospital stay, and non-home discharge. Prevention and perioperative management of delirium may optimize surgical outcomes. •Pooled incidence of delirium was 19% after elective surgery in older patients.•Pooled incidence of delirium was 32% after emergency surgery in older patients.•Delirium was associated with increased mortality at 1-month, 6-month, and 1-year.•Delirium was associated with increased odds of many adverse postoperative outcomes.
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ObjectType-Evidence Based Healthcare-1
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ISSN:0952-8180
1873-4529
1873-4529
DOI:10.1016/j.jclinane.2023.111221