Association of general anesthesia exposure with risk of postoperative delirium in patients receiving transcatheter aortic valve replacement: a meta-analysis and systematic review

Abstract

The aim of this meta-analysis was to assess the association of general anesthesia (GA) exposure with the risk of POD in this patient population. Databases including Medline, EMBASE, Cochrane library, and Google Scholar were searched from inception to December 2022. Analysis of 17 studies published between 2015 and 2021 involving 10,678 individuals revealed an association of GA exposure with an elevated risk of POD [odd ratio (OR) = 1.846, 95% CI 1.329 to 2.563, p = 0.0003, I² = 68.4%, 10,678 patients]. Subgroup analysis of the diagnostic methods also demonstrated a positive correlation between GA exposure and POD risk when validated methods were used for POD diagnosis (OR = 2.199, 95% CI 1.46 to 3.31, p = 0.0002). Meta-regression analyses showed no significant impact of age, male proportion, and sample size on the correlation between GA and the risk of POD. The reported overall incidence of POD from the included studies regardless of the type of anesthesia was between 0.8 and 27%. Our meta-analysis showed a pooled incidence of 10.3% (95% CI 7% to 15%). This meta-analysis suggested an association of general anesthesia with an elevated risk of postoperative delirium, implying the necessity of implementing appropriate prophylactic strategies against this complication when general anesthesia was used in this clinical setting.

Figure 1

Selection process of studies based on search strategies.

Figure 2

Forest plot showing the risk of postoperative delirium among patients with general anesthesia and those without.

Figure 3

Subgroup analysis demonstrating the association of general anesthesia with the risk of postoperative delirium focusing on the use of validated versus non-validated diagnostic methods.

Figure 4

Meta-regression analysis showing non-significant correlation between patient age and study outcome.

Figure 5

Meta-regression analysis indicating non-significant association between male proportion and study outcome.

Figure 6

Meta-regression analysis demonstrating non-significant correlation between sample size and study outcome.

Figure 7

Forest plot showing the pooled incidence of postoperative delirium based on validated or non-validated methods for postoperative delirium (POD) diagnosis. CI: confidence interval.