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

Abstract Background: Early identification of patients at risk for postoperative delirium is essential because adequate well-timed interventions could reduce the occurrence of delirium and the related detrimental outcomes.Methods: We will conduct a systematic review and individual patient data (IPD) meta-analysis of prognostic studies evaluating the predictive value of risk factors associated with an increased risk of postoperative delirium in elderly patients undergoing elective surgery. We will identify eligible studies through systematic search of MEDLINE, EMBASE, and CINAHL from their inception to May 2020. Eligible studies will enroll older adults (³ 50 years) undergoing elective surgery and assess pre-operative prognostic risk factors for delirium and incidence of delirium measured by a trained individual using a validated delirium assessment tool. Pairs of reviewers will, independently and in duplicate, screen titles and abstracts of identified citations, review the full texts of potentially eligible studies. We will contact chief investigators of eligible studies requesting to share the IPD to a secured repository. We will use one-stage approach for IPD meta-analysis and will assess certainty of evidence using the GRADE approach.Discussion: Since we are using existing anonymized data, ethical approval is not required for this study. Our results can be used to guide clinical decisions about the most efficient way to prevent postoperative delirium in elderly patients. Systematic review registration: CRD42020171366

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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

10.21203/rs.3.rs-41459/v1 ◽

2020 ◽

Author(s):

Tayler A Buchan ◽

Behnam Sadeghirad ◽

Nayeli Schmutz ◽

Nicolai Goettel ◽

Farid Foroutan ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Elderly Patients ◽

Postoperative Delirium ◽

Individual Patient Data ◽

Elective Surgery ◽

Meta Analysis ◽

Patient Data ◽

Factors Associated ◽

Increased Risk

Abstract Background: Early identification of patients at risk for postoperative delirium is essential because adequate well-timed interventions could reduce the occurrence of delirium and the related detrimental outcomes.Methods: We will conduct a systematic review and individual patient data (IPD) meta-analysis of prognostic studies evaluating the predictive value of risk factors associated with an increased risk of postoperative delirium in elderly patients undergoing elective surgery. We will identify eligible studies through systematic search of MEDLINE, EMBASE, and CINAHL from their inception to May 2020. Eligible studies will enroll older adults (≥ 50 years) undergoing elective surgery and assess pre-operative prognostic risk factors for delirium and incidence of delirium measured by a trained individual using a validated delirium assessment tool. Pairs of reviewers will, independently and in duplicate, screen titles and abstracts of identified citations, review the full texts of potentially eligible studies. We will contact chief investigators of eligible studies requesting to share the IPD to a secured repository. We will use one-stage approach for IPD meta-analysis and will assess certainty of evidence using the GRADE approach.Discussion: Since we are using existing anonymized data, ethical approval is not required for this study. Our results can be used to guide clinical decisions about the most efficient way to prevent postoperative delirium in elderly patients.

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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

Systematic Reviews ◽

10.1186/s13643-020-01518-z ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Tayler A. Buchan ◽

Behnam Sadeghirad ◽

Nayeli Schmutz ◽

Nicolai Goettel ◽

Farid Foroutan ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Elderly Patients ◽

Postoperative Delirium ◽

Individual Patient Data ◽

Elective Surgery ◽

Meta Analysis ◽

Patient Data ◽

Factors Associated ◽

Increased Risk

Abstract Background Early identification of patients at risk for postoperative delirium is essential because adequate well-timed interventions could reduce the occurrence of delirium and the related detrimental outcomes. Methods We will conduct a systematic review and individual patient data (IPD) meta-analysis of prognostic studies evaluating the predictive value of risk factors associated with an increased risk of postoperative delirium in elderly patients undergoing elective surgery. We will identify eligible studies through systematic search of MEDLINE, EMBASE, and CINAHL from their inception to May 2020. Eligible studies will enroll older adults (≥ 50 years) undergoing elective surgery and assess pre-operative prognostic risk factors for delirium and incidence of delirium measured by a trained individual using a validated delirium assessment tool. Pairs of reviewers will, independently and in duplicate, screen titles and abstracts of identified citations, review the full texts of potentially eligible studies. We will contact chief investigators of eligible studies requesting to share the IPD to a secured repository. We will use one-stage approach for IPD meta-analysis and will assess certainty of evidence using the GRADE approach. Discussion Since we are using existing anonymized data, ethical approval is not required for this study. Our results can be used to guide clinical decisions about the most efficient way to prevent postoperative delirium in elderly patients. Systematic review registration CRD42020171366.

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Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses

BMJ Open ◽

10.1136/bmjopen-2018-024086 ◽

2018 ◽

Vol 8 (12) ◽

pp. e024086 ◽

Cited By ~ 22

Author(s):

Kapil Gupta ◽

Mahesh Nagappa ◽

Arun Prasad ◽

Lusine Abrahamyan ◽

Jean Wong ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Respiratory Depression ◽

Meta Analysis ◽

Sleep Apnoea ◽

Factors Associated ◽

Obstructive Sleep ◽

Increased Risk ◽

Daily Dose ◽

Morphine Equivalent

ObjectiveThis systematic review and meta-analysis aim to evaluate the risk factors associated with postoperative opioid-induced respiratory depression (OIRD).DesignSystematic review and meta-analysis.Data sourcesPubMed-MEDLINE, MEDLINE in-process, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed and Clinicaltrials.gov (January 1946 to November 2017).Eligibility criteriaThe inclusion criteria were: (1) adult patients 18 years or older who were administered opioids after surgery and developed postoperative OIRD (OIRD group); (2) all studies which reported both OIRD events and associated risk factors; (3) all studies with reported data for each risk factor on patients with no OIRD (control group) and (4) published articles in English language.Data analysisWe used a random effects inverse variance analysis to evaluate the existing evidence of risk factors associated with OIRD. Newcastle-Ottawa scale scoring system was used to assess quality of study.ResultsTwelve observational studies were included from 8690 citations. The incidence of postoperative OIRD was 5.0 cases per 1000 anaesthetics administered (95% CI: 4.8 to 5.1; total patients: 841 424; OIRD: 4194). Eighty-five per cent of OIRD occurred within the first 24 hours postoperatively. Increased risk for OIRD was associated with pre-existing cardiac disease (OIRD vs control: 42.8% vs 29.6%; OR: 1.7; 95% CI: 1.2 to 2.5; I2: 0%; p<0.002), pulmonary disease (OIRD vs control: 17.8% vs 10.3%; OR: 2.2; 95% CI: 1.3 to 3.6; I2: 0%; p<0.001) and obstructive sleep apnoea (OIRD vs control: 17.9% vs 16.5%; OR: 1.4; 95% CI: 1.2 to 1.7; I2: 31%; p=0.0003). The morphine equivalent daily dose of the postoperative opioids was higher in the OIRD group than in the control; (24.7±14 mg vs 18.9±13.0 mg; mean difference: 2.8; 95% CI: 0.4 to 5.3; I2: 98%; p=0.02). There was no significant association between OIRD and age, gender, body mass index or American Society of Anesthesiologists physical status.ConclusionPatients with cardiac, respiratory disease and/or obstructive sleep apnoea were at increased risk for OIRD. Patients with postoperative OIRD received higher doses of morphine equivalent daily dose.

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Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis

Clinical Interventions in Aging ◽

10.2147/cia.s201323 ◽

2019 ◽

Vol Volume 14 ◽

pp. 1095-1117 ◽

Cited By ~ 23

Author(s):

T.L. Janssen ◽

A.R. Alberts ◽

L. Hooft ◽

Francesco U.S. Mattace-Raso ◽

C.A. Mosk ◽

...

Keyword(s):

Systematic Review ◽

Elderly Patients ◽

Postoperative Delirium ◽

Elective Surgery ◽

Meta Analysis

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Common Risk Factors for Postoperative Delirium in Elderly Patients with Different Surgical Procedures: a Systematic Review and Meta-analysis of Large Cohort Studies

10.37766/inplasy2021.12.0119 ◽

2021 ◽

Author(s):

Dandan Zhang ◽

◽

Shunluan Tang ◽

Zeyin Zeng ◽

Ping Zhang

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Elderly Patients ◽

Cohort Studies ◽

Surgical Procedures ◽

Postoperative Delirium ◽

Meta Analysis ◽

Large Cohort ◽

Common Risk Factors

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Risk factors for postoperative delirium following hip fracture repair in elderly patients: a systematic review and meta-analysis

Aging Clinical and Experimental Research ◽

10.1007/s40520-016-0541-6 ◽

2016 ◽

Vol 29 (2) ◽

pp. 115-126 ◽

Cited By ~ 57

Author(s):

Yanjiang Yang ◽

Xin Zhao ◽

Tianhua Dong ◽

Zongyou Yang ◽

Qi Zhang ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Hip Fracture ◽

Elderly Patients ◽

Postoperative Delirium ◽

Meta Analysis ◽

Fracture Repair

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Incidence, Outcome And Risk Factors of Postoperative Delirium Subtypes, A Systematic Review And Meta-Analysis

10.21203/rs.3.rs-963630/v1 ◽

2021 ◽

Author(s):

Qian Li ◽

Jingfei Guo ◽

Jia Shi

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Postoperative Delirium ◽

Elective Surgery ◽

Case Reports ◽

Meta Analysis ◽

Related Information ◽

Analysis Methodology ◽

Randomized Control ◽

Meta Analyses

Abstract Objective: Systematic review and meta-analysis methodology was used to estimate the pooled incidence, outcome, risk factors of postoperative delirium, including three delirium subtypes: hyperactive delirium, hypoactive delirium, mixed delirium.Methonds: This systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses(PRISMA) guideline. MEDLINE、EMBASE、CENTRAL were searched for relevant studies. Thirty-two studies from 2714 searched results with 9049 patients were enrolled in this systematic review and meta-analysis. Inclusion criteria were:1) elective surgery population;2) the incidence of delirium subtypes was recorded ;3) cohort studies.;4) language restricted to English. In addition, studies that were randomized control trials (RCT), case reports, or uncertainty in the incidence of delirium subtypes were excluded. The related information was extracted by two reviewers independently.All the analyses were conducted by the STATA (Version 16.0; Stata Corporation, College Station, TX).Result: The study we have performed showed that the highest incidence of postoperative delirium was hypoactive (14%[95%CI,12-16%]), followed by hyperactive (12%[95%CI,10-14%]), and the lowest was mixed delirium(9%[95%CI,7-11%]).Conclusion : The highest incidence of postoperative delirium was hypoactive (14%[95%CI,12-16%]), followed by hyperactive (12%[95%CI,10-14%]), and the lowest was mixed delirium(9%[95%CI,7-11%]). Therefore, it is definitely necessary to update and unify the diagnosis of delirium subtypes based on current tremendous clinical research, thus controlling and adjusting the risk factors of subtypes to reduce the incidence of postoperative delirium and improve patients' prognoses.

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