Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis
2019
textabstractIntroduction: Vulnerable or “frail” patients are susceptible to the development of delirium
when exposed to triggers such as surgical procedures. Once delirium occurs, interventions
have little effect on severity or duration, emphasizing the importance of primary prevention.
This review provides an overview of interventions to prevent postoperative delirium in
elderly patients undergoing elective surgery.
Methods: A literature search was conducted in March 2018. Randomized controlled trials
(RCTs) and before-and-after studies on interventions with potential effects on postoperative
delirium in elderly surgical patients were included. Acute admission, planned ICU admission, and cardiac patients were excluded. Full texts were reviewed, and quality was assessed
by two independent reviewers. Primary outcome was the incidence of delirium. Secondary
outcomes were severity and duration of delirium. Pooled risk ratios (RRs) were calculated
for incidences of delirium where similar intervention techniques were used.
Results: Thirty-one RCTs and four before-and-after studies were included for analysis. In 19
studies, intervention decreased the incidences of postoperative delirium. Severity was
reduced in three out of nine studies which reported severity of delirium. Duration was
reduced in three out of six studies. Pooled analysis showed a significant reduction in delirium
incidence for dexmedetomidine treatment, and bispectral index (BIS)-guided anaesthesia.
Based on sensitivity analyses, by leaving out studies with a high risk of bias, multicomponent
interventions and antipsychotics can also significantly reduce the incidence of delirium.
Conclusion: Multicomponent interventions, the use of antipsychotics, BIS-guidance, and
dexmedetomidine treatment can successfully reduce the incidence of postoperative delirium
in elderly patients undergoing elective, non-cardiac surgery. However, present studies are
heterogeneous, and high-quality studies are scarce. Future studies should add these preventive methods to already existing multimodal and multidisciplinary interventions to tackle as
many precipitating factors as possible, starting in the pre-admission period.
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