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Meta-Analysis
. 2023 Oct 2;6(10):e2337239.
doi: 10.1001/jamanetworkopen.2023.37239.

Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery: An Individual Patient Data Meta-Analysis

Behnam Sadeghirad  1   2   3 , Benjamin T Dodsworth  4 , Nayeli Schmutz Gelsomino  4   5 , Nicolai Goettel  6 , Jessica Spence  1   2 , Tayler A Buchan  1 , Holly N Crandon  3 , Mohammad R Baneshi  7 , Robert A Pol  8 , Baukje Brattinga  8 , Ui Jun Park  9 , Masanori Terashima  10 , Louise B D Banning  8 , Barbara L Van Leeuwen  8 , Bjørn E Neerland  11 , Alwin Chuan  12   13 , Felipe T Martinez  14 , Jeroen L A Van Vugt  15 , Y Raja Rampersaud  16 , Shingo Hatakeyama  17 , Enrico Di Stasio  18   19 , Koen Milisen  20   21 , Bastiaan Van Grootven  20   22 , Lijckle van der Laan  23 , Linda Thomson Mangnall  24 , Sarah J Goodlin  25 , Diana Lungeanu  26 , Kris Denhaerynck  22 , Vibhawari Dhakharia  27 , Elizabeth L Sampson  28   29 , Michael G Zywiel  16 , Lisa Falco  30 , Anna-Lisa V Nguyen  31 , Stephana J Moss  32   33 , Karla D Krewulak  32 , Natalia Jaworska  32 , Kara Plotnikoff  32 , Supun Kotteduwa-Jayawarden  34 , Ryan Sandarage  35 , Jason W Busse  1   2   36 , Lawrence Mbuagbaw  1   2   37   38   39
Affiliations
Meta-Analysis

Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery: An Individual Patient Data Meta-Analysis

Behnam Sadeghirad et al. JAMA Netw Open. .

Abstract

Importance: Postoperative delirium (POD) is a common and serious complication after surgery. Various predisposing factors are associated with POD, but their magnitude and importance using an individual patient data (IPD) meta-analysis have not been assessed.

Objective: To identify perioperative factors associated with POD and assess their relative prognostic value among adults undergoing noncardiac surgery.

Data sources: MEDLINE, EMBASE, and CINAHL from inception to May 2020.

Study selection: Studies were included that (1) enrolled adult patients undergoing noncardiac surgery, (2) assessed perioperative risk factors for POD, and (3) measured the incidence of delirium (measured using a validated approach). Data were analyzed in 2020.

Data extraction and synthesis: Individual patient data were pooled from 21 studies and 1-stage meta-analysis was performed using multilevel mixed-effects logistic regression after a multivariable imputation via chained equations model to impute missing data.

Main outcomes and measures: The end point of interest was POD diagnosed up to 10 days after a procedure. A wide range of perioperative risk factors was considered as potentially associated with POD.

Results: A total of 192 studies met the eligibility criteria, and IPD were acquired from 21 studies that enrolled 8382 patients. Almost 1 in 5 patients developed POD (18%), and an increased risk of POD was associated with American Society of Anesthesiologists (ASA) status 4 (odds ratio [OR], 2.43; 95% CI, 1.42-4.14), older age (OR for 65-85 years, 2.67; 95% CI, 2.16-3.29; OR for >85 years, 6.24; 95% CI, 4.65-8.37), low body mass index (OR for body mass index <18.5, 2.25; 95% CI, 1.64-3.09), history of delirium (OR, 3.9; 95% CI, 2.69-5.66), preoperative cognitive impairment (OR, 3.99; 95% CI, 2.94-5.43), and preoperative C-reactive protein levels (OR for 5-10 mg/dL, 2.35; 95% CI, 1.59-3.50; OR for >10 mg/dL, 3.56; 95% CI, 2.46-5.17). Completing a college degree or higher was associated with a decreased likelihood of developing POD (OR 0.45; 95% CI, 0.28-0.72).

Conclusions and relevance: In this systematic review and meta-analysis of individual patient data, several important factors associated with POD were found that may help identify patients at high risk and may have utility in clinical practice to inform patients and caregivers about the expected risk of developing delirium after surgery. Future studies should explore strategies to reduce delirium after surgery.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Sadeghirad reported receiving partial funding by PIPRA-AG. during the conduct of the study. Dr Dodsworth reported receiving grants from EIT Health during the conduct of the study; and BTD is a founder, shareholder and employee of PIPRA AG (Zurich, Switzerland). Dr Schmutz Gelsomino reported receiving grants from EIT Health during the conduct of the study and being a founder, shareholder, and employee of PIPRA AG (Zürich, Switzerland). Dr Goettel reported receiving personal fees from PIPRA AG during the conduct of the study. Dr Spence reported receiving grants from AOP Global Health, personal fees from Trimedic Pharmaceuticals, and personal fees from PhaseBio outside the submitted work. Dr Chuan reported receiving grants from ANZCA Research grant, personal fees from GE Healthcare Speaker fees, and grants from MRFF Research grant outside the submitted work; in addition, Dr Chuan reported receiving royalties from Oxford University Press for Regional Anaesthesia: A Pocket Guide. Dr Goodlin reported that data acquisition was conducted while he was an employee of the Veterans Affairs Medical Center and with funds for a research associate provided by the Veterans Affairs. Dr Zywiel reported receiving personal fees from DePuy Synthes outside the submitted work. Dr Busse reported receiving support, in part, by a Canadian Institutes of Health Research Canada Research Chair in the prevention and management of chronic pain. Dr Mbuagbaw reported receiving grants from PIPRA during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Flow Diagram for Study Selection
IPD indicates individual patient data.
See this image and copyright information in PMC

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