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

Tayler A Buchan^{1

2}, Behnam Sadeghirad^{3

4}, Nayeli Schmutz^{5

6}, Nicolai Goettel^{7

8}, Farid Foroutan^{1

2}, Rachel Couban⁹, Lawrence Mbuagbaw^{2

10}, Benjamin T Dodsworth⁵

Affiliations

¹ Ted Rogers Center for Heart Research, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
³ Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. sadeghb@mcmaster.ca.
⁴ Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. sadeghb@mcmaster.ca.
⁵ PIPRA AG, Josefstrasse 219, 8005, Zürich, Switzerland.
⁶ St. Claraspital, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
⁷ Department of Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland.
⁸ Department of Clinical Research, University of Basel, Schanzenstrasse 55, CH-4031, Basel, Switzerland.
⁹ Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
¹⁰ Biostatistics Unit/The Research Institute, St. Joseph's Healthcare, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.

PMID: 33189147
PMCID: PMC7666505
DOI: 10.1186/s13643-020-01518-z

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

Tayler A Buchan et al. Syst Rev. 2020.

. 2020 Nov 14;9(1):261.

doi: 10.1186/s13643-020-01518-z.

Authors

Tayler A Buchan^{1

2}, Behnam Sadeghirad^{3

4}, Nayeli Schmutz^{5

6}, Nicolai Goettel^{7

8}, Farid Foroutan^{1

2}, Rachel Couban⁹, Lawrence Mbuagbaw^{2

10}, Benjamin T Dodsworth⁵

Affiliations

¹ Ted Rogers Center for Heart Research, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
³ Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. sadeghb@mcmaster.ca.
⁴ Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. sadeghb@mcmaster.ca.
⁵ PIPRA AG, Josefstrasse 219, 8005, Zürich, Switzerland.
⁶ St. Claraspital, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
⁷ Department of Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland.
⁸ Department of Clinical Research, University of Basel, Schanzenstrasse 55, CH-4031, Basel, Switzerland.
⁹ Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
¹⁰ Biostatistics Unit/The Research Institute, St. Joseph's Healthcare, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.

PMID: 33189147
PMCID: PMC7666505
DOI: 10.1186/s13643-020-01518-z

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 .

Keywords: Elderly; Individual patient data meta-analysis; Postoperative; Prognostic factors.

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Conflict of interest statement

PIPRA AG will develop a commercial presurgical risk assessment tool based on the findings of this meta-analysis. BS and LM received funding from PIPRA AG for conducting this systematic review and IPD meta-analysis. BS is a member of GRADE Working Group. NG has received consultancy fees from PIPRA AG. NS and BTD are founders, shareholders, and employees of PIPRA AG.

References

1. Story DA, Leslie K, Myles PS, Fink M, Poustie SJ, Forbes A, et al. Complications and mortality in older surgical patients in Australia and New Zealand (the REASON study): a multicentre, prospective, observational study. Anaesthesia. 2010;65(10):1022–1030. doi: 10.1111/j.1365-2044.2010.06478.x. - DOI - PubMed
1. Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Anesthesiology. 2018;129(5):872–879. doi: 10.1097/ALN.0000000000002334. - DOI - PubMed
1. Sanders RD, Pandharipande PP, Davidson AJ, Ma D, Maze M. Anticipating and managing postoperative delirium and cognitive decline in adults. BMJ. 2011;343:d4331. doi: 10.1136/bmj.d4331. - DOI - PubMed
1. Witlox J, Eurelings LSM, de Jonghe JFM, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443–451. doi: 10.1001/jama.2010.1013. - DOI - PubMed
1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet (London, England) 2014;383(9920):911–922. doi: 10.1016/S0140-6736(13)60688-1. - DOI - PMC - PubMed

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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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical