Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal.
Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal; Department of Psychiatry, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal.
J Am Med Dir Assoc. 2021 Mar;22(3):613-620.e9. doi: 10.1016/j.jamda.2020.08.017. Epub 2020 Oct 1.
Delirium is an acute neuropsychiatric syndrome associated with poor outcomes. Older adults undergoing surgery have a higher risk of manifesting perioperative delirium, particularly those having associated comorbidities. It remains unclear whether delirium frequency varies across surgical settings and if it has remained stable across the years. We conducted a systematic review to (1) determine the overall frequency of delirium in older people undergoing noncardiac surgery; (2) explore factors explaining the variability of the estimates; and (3) determine the changing of the estimates over the past 2 decades.
Systematic review and meta-analysis. Literature search was performed in MEDLINE, PubMed, ISI Web of Science, EBSCO, ISRCTN registry, ScienceDirect, and Embase in January 2020 for studies published from 1995 to 2020.
Noncardiac surgical settings.
Forty-nine studies were included with a total of 26,865 patients screened for delirium.
We included observational and controlled trials reporting incidence, prevalence, or proportion of delirium in adults aged ≥60 years undergoing any noncardiac surgery requiring hospitalization. Data extracted included sample size, reported delirium frequencies, surgery type, anesthesia type, delirium diagnosis method, length of hospitalization, and year of assessment. (PROSPERO registration no.: CRD42020160045).
We found an overall pooled frequency of preoperative delirium of 17.9% and postoperative delirium (POD) of 23.8%. The POD estimates increased between 1995 and 2020 at an average rate of 3% per year. Pooled estimates of POD were significantly higher in studies not excluding patients with lower cognitive performance before surgery (28% vs 16%) and when general anesthesia was used in comparison to local, spinal, or epidural anesthesia (28% vs 20%).
Type of anesthesia and preoperative cognitive status were significant moderators of delirium frequency. POD in noncardiac surgery has been increasing across the years, suggesting that more resources should be allocated to delirium prevention and management.
谵妄是一种与不良预后相关的急性神经精神综合征。接受手术的老年人发生围手术期谵妄的风险更高，尤其是那些合并有合并症的患者。目前尚不清楚谵妄的发生率是否因手术环境的不同而有所差异，以及其在过去几年是否保持稳定。我们进行了一项系统综述，以确定（1）接受非心脏手术的老年人中谵妄的总体发生率；（2）探讨解释这些估计值差异的因素；（3）确定过去 20 年来这些估计值的变化情况。
系统综述和荟萃分析。于 2020 年 1 月在 MEDLINE、PubMed、ISI Web of Science、EBSCO、ISRCTN 注册处、ScienceDirect 和 Embase 中进行文献检索，以查找 1995 年至 2020 年期间发表的研究。
非心脏手术环境。
共有 49 项研究纳入，共纳入 26865 例筛查谵妄的患者。
我们纳入了报告发病率、患病率或接受任何需要住院的非心脏手术的年龄≥60 岁的成年人中谵妄比例的观察性和对照试验。提取的数据包括样本量、报告的谵妄发生率、手术类型、麻醉类型、谵妄诊断方法、住院时间和评估年份。（PROSPERO 注册号：CRD42020160045）。
我们发现术前谵妄的总体发生率为 17.9%，术后谵妄（POD）为 23.8%。1995 年至 2020 年期间，POD 估计值每年以 3%的速度增长。在未排除术前认知功能较低的患者的研究中，POD 的汇总估计值明显更高（28%比 16%），与局部、脊髓或硬膜外麻醉相比，全身麻醉时的 POD 估计值也更高（28%比 20%）。
麻醉类型和术前认知状态是谵妄发生率的显著调节因素。非心脏手术中的 POD 近年来一直在增加，这表明应该投入更多资源用于预防和管理谵妄。
