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

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Author(s)
Behnam SadeghiradBenjamin T DodsworthNayeli Schmutz GelsominoNicolai GoettelJessica SpenceTayler A BuchanHolly N CrandonMohammad R BaneshiRobert A PolBaukje BrattingaUi Jun ParkMasanori TerashimaLouise B D BanningBarbara L Van LeeuwenBjørn E NeerlandAlwin ChuanFelipe T MartinezJeroen L A Van VugtY Raja RampersaudShingo HatakeyamaEnrico Di StasioKoen MilisenBastiaan Van GrootvenLijckle van der LaanLinda Thomson MangnallSarah J GoodlinDiana LungeanuKris DenhaerynckVibhawari DhakhariaElizabeth L SampsonMichael G ZywielLisa FalcoAnna-Lisa V NguyenStephana J MossKarla D KrewulakNatalia JaworskaKara PlotnikoffSupun Kotteduwa-JayawardenRyan SandarageJason W BusseLawrence Mbuagbaw
Keimyung Author(s)
Park, Ui Jun
Department
Dept. of Surgery (외과학)
Journal Title
JAMA Netw Open
Issued Date
2023
Volume
6
Issue
10
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.
Keimyung Author(s)(Kor)
박의준
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
2574-3805
Source
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810488
DOI
10.1001/jamanetworkopen.2023.37239
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45532
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Surgery (외과학)
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