Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis

TL Janssen,1 AR Alberts,1 L Hooft,2 FUS Mattace-Raso,3 CA Mosk,1 L van der Laan11Department of Surgery, Amphia Hospital Breda, Breda, The Netherlands; 2Cochrane Netherlands, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; 3Department o...

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Autores principales:	Janssen TL, Alberts AR, Hooft L, Mattace-Raso FUS, Mosk CA, van der Laan L
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	prevention postoperative delirium elderly elective surgery Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/2be84b7d6590494baf3a43ec9ad64361
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spelling	oai:doaj.org-article:2be84b7d6590494baf3a43ec9ad643612021-12-02T03:37:21ZPrevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis1178-1998https://doaj.org/article/2be84b7d6590494baf3a43ec9ad643612019-06-01T00:00:00Zhttps://www.dovepress.com/prevention-of-postoperative-delirium-in-elderly-patients-planned-for-e-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998TL Janssen,1 AR Alberts,1 L Hooft,2 FUS Mattace-Raso,3 CA Mosk,1 L van der Laan11Department of Surgery, Amphia Hospital Breda, Breda, The Netherlands; 2Cochrane Netherlands, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; 3Department of Geriatrics, Erasmus MC University Hospital Rotterdam, Rotterdam, The NetherlandsIntroduction: 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.Keywords: prevention, postoperative delirium, elderly, elective surgeryJanssen TLAlberts ARHooft LMattace-Raso FUSMosk CAvan der Laan LDove Medical Pressarticlepreventionpostoperative deliriumelderlyelective surgeryGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 14, Pp 1095-1117 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	prevention postoperative delirium elderly elective surgery Geriatrics RC952-954.6
spellingShingle	prevention postoperative delirium elderly elective surgery Geriatrics RC952-954.6 Janssen TL Alberts AR Hooft L Mattace-Raso FUS Mosk CA van der Laan L Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis
description	TL Janssen,1 AR Alberts,1 L Hooft,2 FUS Mattace-Raso,3 CA Mosk,1 L van der Laan11Department of Surgery, Amphia Hospital Breda, Breda, The Netherlands; 2Cochrane Netherlands, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; 3Department of Geriatrics, Erasmus MC University Hospital Rotterdam, Rotterdam, The NetherlandsIntroduction: 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.Keywords: prevention, postoperative delirium, elderly, elective surgery
format	article
author	Janssen TL Alberts AR Hooft L Mattace-Raso FUS Mosk CA van der Laan L
author_facet	Janssen TL Alberts AR Hooft L Mattace-Raso FUS Mosk CA van der Laan L
author_sort	Janssen TL
title	Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis
title_short	Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis
title_full	Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis
title_fullStr	Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis
title_full_unstemmed	Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis
title_sort	prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/2be84b7d6590494baf3a43ec9ad64361
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Prevention of postoperative delirium in elderly patients planned for elective surgery: systematic review and meta-analysis

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