Risk factors and incidence of postoperative delirium after cardiac surgery in children: a systematic review and meta-analysis

Abstract

Delirium, a form of acute cerebral dysfunction, is a common complication of postoperative cardiac surgery in children. It is strongly associated with adverse outcomes, including prolonged hospitalization, increased mortality, and cognitive dysfunction. This study aimed to identify risk factors and incidence of delirium after cardiac surgery in children to facilitate early identification of delirium risk and provide a reference for the implementation of effective prevention and management. A systematic literature search was conducted in PubMed, Web of Science, Embase, Cochrane Library, Scopus, CNKI, Sinomed, and Wanfang for studies published in English or Chinese from the inception of each database to November 2023. The PRISMA guidelines were followed in all phases of this systematic review. The Risk of Bias Assessment for Nonrandomized Studies tool was used to assess methodological quality. A total of twelve studies were included in the analysis, with four studies classified as overall low risk of bias, seven studies as moderate risk of bias, and one study as high risk of bias. The studies reported 39 possible predictors of delirium, categorized into four broad groups: intrinsic and parent-related factors, disease-related factors, surgery and treatment-related factors, and clinical scores and laboratory parameters. By conducting qualitative synthesis and quantitative meta-analysis, we identified two definite factors, four possible factors, and 32 unclear factors related to delirium. Definite risk factors included age and mechanical ventilation duration. Possible factors included developmental delay, cyanotic heart disease, cardiopulmonary bypass time, and pain score. With only a few high-quality studies currently available, well-designed and more extensive prospective studies are still needed to investigate the risk factors affecting delirium and explore delirium prevention strategies in high-risk children.

Keywords: Cardiac surgery; Delirium; Meta-analysis; Risk factors; Systematic review.

Fig. 1

Flow chart of the systematic literature search

Fig. 2

Summary of risk of bias in the included studies

Fig. 3

Meta-analysis of intrinsic factors. Forest plots of odds ratios (ORs) that were included in the quantitative meta-analysis and the associated overall ORs. For each OR, the size of the red square region is proportional to the corresponding study weight. Diamond shapes intervals represent the overall ORs. I² represents the fraction of variability among the individual ORs that cannot be explained by sampling variability

Fig. 4

Meta-analysis of disease-related factors

Fig. 5

Meta-analysis of surgery and treatment-related factors

Fig. 6

Meta-analysis of clinical scores and laboratory parameters