Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients

Abstract

Postoperative delirium (POD) remains a common, dangerous and resource-consuming adverse event but is often preventable. The whole peri-operative team can play a key role in its management. This update to the 2017 ESAIC Guideline on the prevention of POD is evidence-based and consensus-based and considers the literature between 01 April 2015, and 28 February 2022. The search terms of the broad literature search were identical to those used in the first version of the guideline published in 2017. POD was defined in accordance with the DSM-5 criteria. POD had to be measured with a validated POD screening tool, at least once per day for at least 3 days starting in the recovery room or postanaesthesia care unit on the day of surgery or, at latest, on postoperative day 1. Recent literature confirmed the pathogenic role of surgery-induced inflammation, and this concept reinforces the positive role of multicomponent strategies aimed to reduce the surgical stress response. Although some putative precipitating risk factors are not modifiable (length of surgery, surgical site), others (such as depth of anaesthesia, appropriate analgesia and haemodynamic stability) are under the control of the anaesthesiologists. Multicomponent preoperative, intra-operative and postoperative preventive measures showed potential to reduce the incidence and duration of POD, confirming the pivotal role of a comprehensive and team-based approach to improve patients' clinical and functional status.

Fig. 1

STEP 1: flow chart of the study selection process from April 2015 until November 2020 (search 1).

Fig. 2

STEP 2: flow chart of the study selection process December 2020 until February 2022 (search 2).

Fig. 3

Forest plot for postoperative delirium outcomes in dexmedetomidine vs. placebo.

Fig. 4

Forest plot for postoperative delirium outcomes in dexmedetomidine vs. other drugs.

Fig. 5

Forest plot for postoperative delirium outcomes in multicomponent interventions vs. usual care, n = 8 studies.

Fig. 6

Forest plot for postoperative delirium outcomes in multicomponent interventions vs. usual care after (comprehensive) geriatric assessment plus tailored interventions, n = 6 studies.

Fig. 7

Forest plot using inverse variance heterogeneity model analysis for postoperative delirium outcomes on intraoperative processed EEG Neuromonitoring guidance vs. usual intraoperative care or comparing deep anaesthesia vs. light anaesthesia in older patients, n = 8 studies.

Fig. 8

Forest plot for mortality in patients with postoperative delirium after noncardiac surgery vs. patients with no postoperative delirium. The corresponding Funnel plot is shown in Supplement Figure S11.

Fig. 9

Forest plot for overall mortality in patients with postoperative delirium after cardiac surgery vs. patients with no postoperative delirium. The corresponding Funnel plot is shown in Supplement Figure S12.

Fig. 10

Forest plot for length of ICU stay in hours in patients with postoperative delirium after cardiac surgery vs. patients with no postoperative delirium. The corresponding Funnel plot is shown in Supplement Figure S13.

Fig. 11

Forest plot for hospital length of stay in days in patients with postoperative delirium after noncardiac surgery vs. patients with no postoperative delirium. The corresponding Funnel plot is shown in Supplement Figure S14.

Fig. 12

Forest plot for hospital length of stay in days in patients with postoperative delirium after cardiac surgery vs. patients with no postoperative delirium. The corresponding Funnel plot is shown in Supplement Figure S15.

Fig. 13

Forest plot of need for nursing care in patients with postoperative delirium after noncardiac surgery vs. patients with no postoperative delirium. The corresponding Funnel plot is shown in Supplement Figure S16.