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Identifying Older Adults at Risk of Delirium Following Elective Surgery: A Systematic Review and Meta-Analysis
- Source :
- Journal of General Internal Medicine
- Publication Year :
- 2017
-
Abstract
- Background Postoperative delirium is a common preventable complication experienced by older adults undergoing elective surgery. In this systematic review and meta-analysis, we identified prognostic factors associated with the risk of postoperative delirium among older adults undergoing elective surgery. Methods Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and AgeLine were searched for articles published between inception and April 21, 2016. A total of 5692 titles and abstracts were screened in duplicate for possible inclusion. Studies using any method for diagnosing delirium were eligible. Two reviewers independently completed all data extraction and quality assessments using the Cochrane Risk-of-Bias Tool for randomized controlled trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for cohort studies. Random effects meta-analysis models were used to derive pooled effect estimates. Results Forty-one studies (9384 patients) reported delirium-related prognostic factors. Among our included studies, the pooled incidence of postoperative delirium was 18.4% (95% confidence interval [CI] 14.3–23.3%, number needed to follow [NNF] = 6). Geriatric syndromes were important predictors of delirium, namely history of delirium (odds ratio [OR] 6.4, 95% CI 2.2–17.9), frailty (OR 4.1, 95% CI 1.4–11.7), cognitive impairment (OR 2.7, 95% CI 1.9–3.8), impairment in activities of daily living (ADLs; OR 2.1, 95% CI 1.6–2.6), and impairment in instrumental activities of daily living (IADLs; OR 1.9, 95% CI 1.3–2.8). Potentially modifiable prognostic factors such as psychotropic medication use (OR 2.3, 95% CI 1.4–3.6) and smoking status (OR 1.8 95% CI 1.3–2.4) were also identified. Caregiver support was associated with lower odds of postoperative delirium (OR 0.69, 95% CI 0.52–0.91). Discussion Though caution must be used in interpreting meta-analyses of non-randomized studies due to the potential influence of unmeasured confounding, we identified potentially modifiable prognostic factors including frailty and psychotropic medication use that should be targeted to optimize care. Electronic supplementary material The online version of this article (10.1007/s11606-017-4204-x) contains supplementary material, which is available to authorized users.
- Subjects :
- medicine.medical_specialty
Activities of daily living
perioperative medicine
law.invention
03 medical and health sciences
0302 clinical medicine
Emergence Delirium
Randomized controlled trial
law
Risk Factors
Internal medicine
Activities of Daily Living
Internal Medicine
medicine
Humans
030212 general & internal medicine
Prospective Studies
Elective surgery
10. No inequality
older adults
Aged
Randomized Controlled Trials as Topic
Aged, 80 and over
Review Paper
business.industry
Delirium
prognostic factors
Odds ratio
Middle Aged
Confidence interval
3. Good health
elective surgery
Elective Surgical Procedures
Meta-analysis
medicine.symptom
business
030217 neurology & neurosurgery
Cohort study
Subjects
Details
- ISSN :
- 15251497
- Volume :
- 33
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of general internal medicine
- Accession number :
- edsair.doi.dedup.....e087a6c8f51173a744bc1359867499d1