Incidence and risk factors for postoperative delirium after liver transplantation: a systematic review and meta-analysis

Abstract

Objective: Postoperative delirium (POD) is a common complication after surgery. The incidence of POD and delirium risk factors after liver transplantation (LT) have not been systematically summarized.

Materials and methods: Databases, such as PubMed, Cochrane Library, and EMBASE were searched up to September 15, 2019. All relevant studies that addressed the incidence and risk factors for POD after LT were included and summarized.

Results: Twenty articles with 3417 patients with LT were included. The pooled overall incidence for POD after LT was 0.16 (95% CI 0.12-0.22). The overall incidence (0.24, 95% CI 0.15-0.35) in Asians was higher than in Caucasians (0.13, 95% CI 0.08-0.19). Encephalopathy (OR 4.16, 95% CI 2.59-6.68, p<0.01), alcoholic liver disease (OR 2.25, 95% CI1.46-3.47, p<0.01), MELD score, midazolam use, duration of ICU stay (day), and duration of hospital stay (day) were significantly associated with POD. POD was a mortality risk factor according to the pooled results of ICU mortality (OR 5.06, 95% CI 1.42-17.99), in-hospital mortality (OR 4.05, 95% CI 1.86-8.84), and one-year mortality (OR 4.21, 95% CI 1.94-9.12).

Conclusions: POD is common after LT and leads to a worse outcome. Several risk factors were consistently associated with POD after LT. The risk factors identified by this study may benefit the prevention and diagnosis of POD. This study is the first to summarize the occurrence of POD after LT.