Association between postoperative delirium and adverse outcomes in older surgical patients: A systematic review and meta-analysis

Ellene Yan; Matthew Veitch; Aparna Saripella; Yasmin Alhamdah; Nina Butris; David F Tang-Wai; Maria Carmela Tartaglia; Mahesh Nagappa; Marina Englesakis; David He; Frances Chung

doi:10.1016/j.jclinane.2023.111221

Association between postoperative delirium and adverse outcomes in older surgical patients: A systematic review and meta-analysis

J Clin Anesth. 2023 Nov:90:111221. doi: 10.1016/j.jclinane.2023.111221. Epub 2023 Jul 27.

Authors

Affiliations

¹ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
² Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
³ Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁶ Library & Information Services, University Health Network, Toronto, ON, Canada.
⁷ Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
⁸ Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada. Electronic address: frances.chung@uhn.ca.

PMID: 37515876
DOI: 10.1016/j.jclinane.2023.111221

Abstract

Study objective: To assess the incidence of postoperative delirium and its outcomes in older non-cardiac surgical patients.

Design: A systematic review and meta-analysis with multiple databases searched from inception to February 22, 2022.

Setting: Postoperative assessments.

Patients: Non-cardiac and non-neurological surgical patients aged ≥60 years with and without postoperative delirium. Included studies must report ≥1 postoperative outcome. Studies with a small sample size (N < 100 subjects) were excluded.

Measurements: Outcomes comprised the pooled incidence of postoperative delirium and its postoperative outcomes, including mortality, complications, unplanned intensive care unit admissions, length of stay, and non-home discharge. For dichotomous and continuous outcomes, OR and difference in means were computed, respectively, with a 95% CI.

Main results: Fifty-four studies (20,988 patients, 31 elective studies, 23 emergency studies) were included. The pooled incidence of postoperative delirium was 19% (95% CI: 16%, 23%) after elective surgery and 32% (95% CI: 25%, 39%) after emergency surgery. In elective surgery, postoperative delirium was associated with increased mortality at 1-month (OR: 6.60; 95% CI: 1.58, 27.66), 6-month (OR: 5.69; 95% CI: 2.33, 13.88), and 1-year (OR: 2.87; 95% CI: 1.63, 5.06). The odds of postoperative complications, unplanned intensive care unit admissions, prolonged length of hospital stay, and non-home discharge were also higher in delirium cases. In emergency surgery, patients with postoperative delirium had greater odds of mortality at 1-month (OR: 3.56; 95% CI: 1.77, 7.15), 6-month (OR: 2.60; 95% CI: 1.88, 3.61), and 1-year (OR: 2.30; 95% CI: 1.77, 3.00).

Conclusions: Postoperative delirium was associated with higher odds of mortality, postoperative complications, unplanned intensive care unit admissions, length of hospital stay, and non-home discharge. Prevention and perioperative management of delirium may optimize surgical outcomes.

Keywords: Adverse outcomes; Older patients; Postoperative complications; Postoperative delirium; Surgery.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Delirium* / epidemiology
Delirium* / etiology
Delirium* / prevention & control
Emergence Delirium*
Hospitalization
Humans
Length of Stay
Postoperative Complications / epidemiology
Postoperative Complications / etiology