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Review
. 2021 Apr 26;16(1):113.
doi: 10.1186/s13019-021-01496-w.

Risk factors of postoperative delirium after cardiac surgery: a meta-analysis

Haiyan Chen  1 , Liang Mo  2 , Hongjuan Hu  3 , Yulan Ou  4 , Juan Luo  5
Affiliations
Review

Risk factors of postoperative delirium after cardiac surgery: a meta-analysis

Haiyan Chen et al. J Cardiothorac Surg. .

Abstract

Background: Postoperative delirium is a frequent event after cardiac surgery. This meta-analysis aimed to identify relevant risk factors.

Method: In this meta-analysis, all original researches regarding patients undergoing mixed types of cardiac surgery (excluding transcatheter procedures) and postoperative delirium were evaluated for inclusion. On July 28th 2020, we searched PubMed, Embase, Web of Science and Scopus. Data about name of first author, year of publication, inclusion and exclusion criteria, research design, setting, method of delirium assessment, incidence of delirium, odds ratio (OR) and corresponding 95% confidence interval (CI) of risk factors, and other information relevant was collected. OR and 95% CI were used as metrics for summarized results. Random effects model was applied.

Results: Fourteen reports were included with a total sample size of 13,286. The incidence of delirium ranged from 4.1 to 54.9%. Eight risk factors were identified including aging, diabetes, preoperative depression, mild cognitive impairment, carotid artery stenosis, NYHA functional class III or IV, time of mechanical ventilation and length of intensive care unit stay.

Conclusion: In this study several risk factors associated with postoperative delirium after cardiac surgery were identified. Utilizing the information may allow us to identifying patients at high risk of developing postoperative delirium prior to delirium onset.

Keywords: Cardiac surgery; Meta-analysis; Postoperative delirium.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The flowchart of literature selection process
Fig. 2
Fig. 2
The forest plots summarizing preoperative risk factors. a Age increase per year. b Age > 65 years. c Carotid artery stenosis. d Diabetes. e Hypertension. f Left ventricular ejection fraction by percentage. g Preoperative depression. h NYHA functional class III or IV. i Preoperative mild cognitive impairment. j Preoperative use of statins. Results were summarized with OR and corresponding 95% CI. I2 statistic was used to assess heterogeneity among studies
Fig. 3
Fig. 3
The forest plots summarizing intra- and postoperative risk factors. a Aortic cross clamp time per minute. b ICU stay per day. c Mechanical ventilation time per hour. Results were summarized with OR and corresponding 95% CI. I2 statistic was used to assess heterogeneity among studies
Fig. 4
Fig. 4
Sensitivity analysis and funnel plot of analyses containing more than 4 studies. a Sensitivity analysis for age increase per year. b Funnel plot for age increase per year. c Sensitivity analysis for diabetes. d Funnel plot for diabetes. e Sensitivity analysis for hypertension. f Funnel plot for hypertension. g Forest plot of hypertension as risk factor after excluding the study that had major impact to pooled result. h Sensitivity analysis for hypertension after excluding the study that had major impact to pooled result. i Funnel plot for hypertension after excluding the study that had major impact to pooled result
See this image and copyright information in PMC

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