Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
J Clin Anesth. 2023 Nov;90:111221. doi: 10.1016/j.jclinane.2023.111221. Epub 2023 Jul 27.
To assess the incidence of postoperative delirium and its outcomes in older non-cardiac surgical patients.
A systematic review and meta-analysis with multiple databases searched from inception to February 22, 2022.
Postoperative assessments.
Non-cardiac and non-neurological surgical patients aged ≥60 years with and without postoperative delirium. Included studies must report ≥1 postoperative outcome. Studies with a small sample size (N < 100 subjects) were excluded.
Outcomes comprised the pooled incidence of postoperative delirium and its postoperative outcomes, including mortality, complications, unplanned intensive care unit admissions, length of stay, and non-home discharge. For dichotomous and continuous outcomes, OR and difference in means were computed, respectively, with a 95% CI.
Fifty-four studies (20,988 patients, 31 elective studies, 23 emergency studies) were included. The pooled incidence of postoperative delirium was 19% (95% CI: 16%, 23%) after elective surgery and 32% (95% CI: 25%, 39%) after emergency surgery. In elective surgery, postoperative delirium was associated with increased mortality at 1-month (OR: 6.60; 95% CI: 1.58, 27.66), 6-month (OR: 5.69; 95% CI: 2.33, 13.88), and 1-year (OR: 2.87; 95% CI: 1.63, 5.06). The odds of postoperative complications, unplanned intensive care unit admissions, prolonged length of hospital stay, and non-home discharge were also higher in delirium cases. In emergency surgery, patients with postoperative delirium had greater odds of mortality at 1-month (OR: 3.56; 95% CI: 1.77, 7.15), 6-month (OR: 2.60; 95% CI: 1.88, 3.61), and 1-year (OR: 2.30; 95% CI: 1.77, 3.00).
Postoperative delirium was associated with higher odds of mortality, postoperative complications, unplanned intensive care unit admissions, length of hospital stay, and non-home discharge. Prevention and perioperative management of delirium may optimize surgical outcomes.
评估老年非心脏手术患者术后谵妄的发生率及其结局。
系统评价和荟萃分析，检索多个数据库，时间从建库至 2022 年 2 月 22 日。
术后评估。
年龄≥60 岁的非心脏和非神经外科手术患者，有无术后谵妄。纳入的研究必须报告至少 1 项术后结局。排除样本量较小（N<100 例）的研究。
结局包括术后谵妄的总发生率及其术后结局，包括死亡率、并发症、非计划转入重症监护病房、住院时间和非居家出院。对于二分类和连续结局，分别计算比值比（OR）和均值差异，均采用 95%置信区间（CI）。
共纳入 54 项研究（20988 例患者，31 项择期手术，23 项急诊手术）。择期手术后，术后谵妄的总发生率为 19%（95%CI：16%，23%），急诊手术后为 32%（95%CI：25%，39%）。择期手术后，1 个月（OR：6.60；95%CI：1.58，27.66）、6 个月（OR：5.69；95%CI：2.33，13.88）和 1 年（OR：2.87；95%CI：1.63，5.06）时，术后谵妄与死亡率增加相关。谵妄病例术后并发症、非计划转入重症监护病房、住院时间延长和非居家出院的几率也更高。急诊手术后，术后谵妄患者 1 个月（OR：3.56；95%CI：1.77，7.15）、6 个月（OR：2.60；95%CI：1.88，3.61）和 1 年（OR：2.30；95%CI：1.77，3.00）时的死亡率更高。
术后谵妄与更高的死亡率、术后并发症、非计划转入重症监护病房、住院时间延长和非居家出院相关。预防和围手术期谵妄管理可能优化手术结局。
