Incidence and assessment of delirium following open cardiac surgery: a systematic review and meta-analysis

Abstract

Aims: This systematic review and meta-analysis sought (i) to provide an overview of the incidence of delirium following open cardiac surgery and (ii) to investigate how incidences of delirium are associated with different assessment tools.

Methods and results: A systematic search of studies investigating delirium following open cardiac surgery was conducted in Medline (Ovid), EMBASE, PsycINFO, CiNAHL, and the Cochrane Database. Only studies with patients diagnosed or screened with a validated tool were included. Studies published from 2005-2021 were included in the meta-analysis. Of 7126 individual studies retrieved, 106 met the inclusion criteria for the meta-analysis, hereof 31% of high quality. The weighted pooled incidence of delirium following open cardiac surgery across all studies was 23% (95% CI 20-26%), however we found a considerable heterogeneity (I2 = 99%), which could not be explained by subgroups or further sensitivity analyses. The most commonly applied screening tool for delirium is CAM/CAM-ICU. The lowest estimates of delirium were found by applying the Delirium Observation Scale (incidence 14%, 95% CI 8-20%), and the highest estimates in studies using 'other' screening tools (Organic Brain Symptom Scale, Delirium Symptom Interview) with a pooled incidence of 43% (95% CI 19-66%), however, only two studies applied these.

Conclusion: Delirium following open cardiac surgery remains a complication with a high incidence of overall 23%, when applying a validated tool for screening or diagnosis. Nevertheless, this systematic review and meta-analyses highlight the significant inconsistency in current evidence regarding assessment tools and regimens.

Registration: Prospero CRD42020215519.

Keywords: Cardiac surgery; Delirium; Validated assessment tools.