Meta-Analysis

. 2023 Oct 2;6(10):e2337239.

doi: 10.1001/jamanetworkopen.2023.37239.

Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery: An Individual Patient Data Meta-Analysis

Behnam Sadeghirad^{1

2

3}, Benjamin T Dodsworth⁴, Nayeli Schmutz Gelsomino^{4

5}, Nicolai Goettel⁶, Jessica Spence^{1

2}, Tayler A Buchan¹, Holly N Crandon³, Mohammad R Baneshi⁷, Robert A Pol⁸, Baukje Brattinga⁸, Ui Jun Park⁹, Masanori Terashima¹⁰, Louise B D Banning⁸, Barbara L Van Leeuwen⁸, Bjørn E Neerland¹¹, Alwin Chuan^{12

13}, Felipe T Martinez¹⁴, Jeroen L A Van Vugt¹⁵, Y Raja Rampersaud¹⁶, Shingo Hatakeyama¹⁷, Enrico Di Stasio^{18

19}, Koen Milisen^{20

21}, Bastiaan Van Grootven^{20

22}, Lijckle van der Laan²³, Linda Thomson Mangnall²⁴, Sarah J Goodlin²⁵, Diana Lungeanu²⁶, Kris Denhaerynck²², Vibhawari Dhakharia²⁷, Elizabeth L Sampson^{28

29}, Michael G Zywiel¹⁶, Lisa Falco³⁰, Anna-Lisa V Nguyen³¹, Stephana J Moss^{32

33}, Karla D Krewulak³², Natalia Jaworska³², Kara Plotnikoff³², Supun Kotteduwa-Jayawarden³⁴, Ryan Sandarage³⁵, Jason W Busse^{1

2

36}, Lawrence Mbuagbaw^{1

2

37

38

39}

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
² Department of Anesthesia, McMaster University, Hamilton, Canada.
³ Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Canada.
⁴ PIPRA AG, Zurich, Switzerland.
⁵ Department of Anesthesiology, University of Basel, Switzerland.
⁶ Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
⁷ The University of Queensland, Australian Women and Girls' Health Research Centre, School of Public Health, Herston Road, Herston, Queensland, Australia.
⁸ Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁹ Transplant & Vascular Surgery, School of Medicine, Keimyung University, Dongsan Hospital, Daegu, South Korea.
¹⁰ Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi-Cho, Shizuoka, Japan.
¹¹ Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
¹² South West Sydney Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia.
¹³ Department of Anaesthesia, Liverpool Hospital, Liverpool, New South Wales, Australia.
¹⁴ Escuela de Medicina, Universidad de Andrés Bello, Viña del Mar, Chile.
¹⁵ Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
¹⁶ Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Ontario, Canada.
¹⁷ Department of Advanced Blood Purification Therapy, Hirosaki Graduate School of Medicine, Hirosaki, Japan.
¹⁸ Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
¹⁹ Dipartimento di scienze laboratoristiche ed infettivologiche, UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
²⁰ Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
²¹ Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
²² Institute of Nursing Science, Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.
²³ Department of Surgery, Amphia Hospital, Breda, the Netherlands.
²⁴ Sydney Adventist Hospital, Wahroonga, New South Wales, Australia.
²⁵ Geriatrics Section, Veterans Affairs Portland Health Services Center and Oregon Health & Science University, Portland, Oregon.
²⁶ Department of Functional Sciences, Centre for Modelling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
²⁷ Department of Gynaecological Oncology, Health Care Global Enterprises Ltd, Bangalore, India.
²⁸ Division of Psychiatry, University College London, London, UK.
²⁹ Department of Psychological Medicine, East London NHS Foundation Trust, Royal London Hospital, London, UK.
³⁰ Zühlke Engineering AG, Schlieren, Switzerland.
³¹ Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
³² Department of Critical Care, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
³³ Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
³⁴ Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³⁵ Department of Surgery, Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada.
³⁶ Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada.
³⁷ Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon.
³⁸ Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
³⁹ Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.

PMID: 37819663
PMCID: PMC10568362
DOI: 10.1001/jamanetworkopen.2023.37239

Meta-Analysis

Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery: An Individual Patient Data Meta-Analysis

Behnam Sadeghirad et al. JAMA Netw Open. 2023.

. 2023 Oct 2;6(10):e2337239.

doi: 10.1001/jamanetworkopen.2023.37239.

Authors

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
² Department of Anesthesia, McMaster University, Hamilton, Canada.
³ Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Canada.
⁴ PIPRA AG, Zurich, Switzerland.
⁵ Department of Anesthesiology, University of Basel, Switzerland.
⁶ Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
⁷ The University of Queensland, Australian Women and Girls' Health Research Centre, School of Public Health, Herston Road, Herston, Queensland, Australia.
⁸ Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁹ Transplant & Vascular Surgery, School of Medicine, Keimyung University, Dongsan Hospital, Daegu, South Korea.
¹⁰ Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi-Cho, Shizuoka, Japan.
¹¹ Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
¹² South West Sydney Clinical School, University of New South Wales Australia, Sydney, New South Wales, Australia.
¹³ Department of Anaesthesia, Liverpool Hospital, Liverpool, New South Wales, Australia.
¹⁴ Escuela de Medicina, Universidad de Andrés Bello, Viña del Mar, Chile.
¹⁵ Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
¹⁶ Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Ontario, Canada.
¹⁷ Department of Advanced Blood Purification Therapy, Hirosaki Graduate School of Medicine, Hirosaki, Japan.
¹⁸ Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
¹⁹ Dipartimento di scienze laboratoristiche ed infettivologiche, UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
²⁰ Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
²¹ Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
²² Institute of Nursing Science, Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.
²³ Department of Surgery, Amphia Hospital, Breda, the Netherlands.
²⁴ Sydney Adventist Hospital, Wahroonga, New South Wales, Australia.
²⁵ Geriatrics Section, Veterans Affairs Portland Health Services Center and Oregon Health & Science University, Portland, Oregon.
²⁶ Department of Functional Sciences, Centre for Modelling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
²⁷ Department of Gynaecological Oncology, Health Care Global Enterprises Ltd, Bangalore, India.
²⁸ Division of Psychiatry, University College London, London, UK.
²⁹ Department of Psychological Medicine, East London NHS Foundation Trust, Royal London Hospital, London, UK.
³⁰ Zühlke Engineering AG, Schlieren, Switzerland.
³¹ Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
³² Department of Critical Care, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
³³ Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
³⁴ Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³⁵ Department of Surgery, Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada.
³⁶ Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada.
³⁷ Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon.
³⁸ Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
³⁹ Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.

PMID: 37819663
PMCID: PMC10568362
DOI: 10.1001/jamanetworkopen.2023.37239

Abstract

Importance: Postoperative delirium (POD) is a common and serious complication after surgery. Various predisposing factors are associated with POD, but their magnitude and importance using an individual patient data (IPD) meta-analysis have not been assessed.

Objective: To identify perioperative factors associated with POD and assess their relative prognostic value among adults undergoing noncardiac surgery.

Data sources: MEDLINE, EMBASE, and CINAHL from inception to May 2020.

Study selection: Studies were included that (1) enrolled adult patients undergoing noncardiac surgery, (2) assessed perioperative risk factors for POD, and (3) measured the incidence of delirium (measured using a validated approach). Data were analyzed in 2020.

Data extraction and synthesis: Individual patient data were pooled from 21 studies and 1-stage meta-analysis was performed using multilevel mixed-effects logistic regression after a multivariable imputation via chained equations model to impute missing data.

Main outcomes and measures: The end point of interest was POD diagnosed up to 10 days after a procedure. A wide range of perioperative risk factors was considered as potentially associated with POD.

Results: A total of 192 studies met the eligibility criteria, and IPD were acquired from 21 studies that enrolled 8382 patients. Almost 1 in 5 patients developed POD (18%), and an increased risk of POD was associated with American Society of Anesthesiologists (ASA) status 4 (odds ratio [OR], 2.43; 95% CI, 1.42-4.14), older age (OR for 65-85 years, 2.67; 95% CI, 2.16-3.29; OR for >85 years, 6.24; 95% CI, 4.65-8.37), low body mass index (OR for body mass index <18.5, 2.25; 95% CI, 1.64-3.09), history of delirium (OR, 3.9; 95% CI, 2.69-5.66), preoperative cognitive impairment (OR, 3.99; 95% CI, 2.94-5.43), and preoperative C-reactive protein levels (OR for 5-10 mg/dL, 2.35; 95% CI, 1.59-3.50; OR for >10 mg/dL, 3.56; 95% CI, 2.46-5.17). Completing a college degree or higher was associated with a decreased likelihood of developing POD (OR 0.45; 95% CI, 0.28-0.72).

Conclusions and relevance: In this systematic review and meta-analysis of individual patient data, several important factors associated with POD were found that may help identify patients at high risk and may have utility in clinical practice to inform patients and caregivers about the expected risk of developing delirium after surgery. Future studies should explore strategies to reduce delirium after surgery.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Sadeghirad reported receiving partial funding by PIPRA-AG. during the conduct of the study. Dr Dodsworth reported receiving grants from EIT Health during the conduct of the study; and BTD is a founder, shareholder and employee of PIPRA AG (Zurich, Switzerland). Dr Schmutz Gelsomino reported receiving grants from EIT Health during the conduct of the study and being a founder, shareholder, and employee of PIPRA AG (Zürich, Switzerland). Dr Goettel reported receiving personal fees from PIPRA AG during the conduct of the study. Dr Spence reported receiving grants from AOP Global Health, personal fees from Trimedic Pharmaceuticals, and personal fees from PhaseBio outside the submitted work. Dr Chuan reported receiving grants from ANZCA Research grant, personal fees from GE Healthcare Speaker fees, and grants from MRFF Research grant outside the submitted work; in addition, Dr Chuan reported receiving royalties from Oxford University Press for Regional Anaesthesia: A Pocket Guide. Dr Goodlin reported that data acquisition was conducted while he was an employee of the Veterans Affairs Medical Center and with funds for a research associate provided by the Veterans Affairs. Dr Zywiel reported receiving personal fees from DePuy Synthes outside the submitted work. Dr Busse reported receiving support, in part, by a Canadian Institutes of Health Research Canada Research Chair in the prevention and management of chronic pain. Dr Mbuagbaw reported receiving grants from PIPRA during the conduct of the study. No other disclosures were reported.

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References

1. Witlox J, Eurelings LSM, de Jonghe JFM, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443-451. doi:10.1001/jama.2010.1013 - DOI - PubMed
1. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911-922. doi:10.1016/S0140-6736(13)60688-1 - DOI - PMC - PubMed
1. Raats JW, van Eijsden WA, Crolla RM, Steyerberg EW, van der Laan L. Risk factors and outcomes for postoperative delirium after major surgery in elderly patients. PLoS One. 2015;10(8):e0136071. doi:10.1371/journal.pone.0136071 - DOI - PMC - PubMed
1. Bickel H, Gradinger R, Kochs E, Förstl H. High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dement Geriatr Cogn Disord. 2008;26(1):26-31. doi:10.1159/000140804 - DOI - PubMed
1. Saczynski JS, Marcantonio ER, Quach L, et al. . Cognitive trajectories after postoperative delirium. N Engl J Med. 2012;367(1):30-39. doi:10.1056/NEJMoa1112923 - DOI - PMC - PubMed

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Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery: An Individual Patient Data Meta-Analysis

Affiliations

Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery: An Individual Patient Data Meta-Analysis

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Abstract

Conflict of interest statement

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