Related Factors and Treatment of Postoperative Delirium in Old Adult Patients: An Integrative Review

Méndez-Martínez, Carlos; Fernández-Martínez, María Nélida; García-Suárez, Mario; Martínez‐Isasi, Santiago; Fernández-Fernández, Jesús Antonio; Fernández‐García, Daniel

doi:10.3390/healthcare9091103

Cited by 10 publications

(12 citation statements)

References 96 publications

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“…As we all know, advanced age is recognised as an independent risk factor for POD. 29 What is more, a study indicated that CCI ≥2 was closely associated with POD. 13 ACCI is a wide comorbidity scoring system by integrating CCI and age, which is commonly used to predict the prognosis in patients with cancer.…”

Section: Discussionmentioning

confidence: 99%

Clinical risk analysis of postoperative delirium in elderly patients undergoing thoracic and abdominal surgery: study protocol of a single-centre observational cohort study

Liu

et al. 2022

BMJ Open

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IntroductionPostoperative delirium (POD) acts as a common complication in older patients after surgery, accompanied by longer recovery time, prolonged hospital stay, increased hospitalisation costs, etc. Therefore, it is urgent to reduce POD by implementing some intervention strategies. Early identification of associated risk factors was regarded as an effective method to lower the incidence of POD. Currently, the incidence and risk factors of POD have been widely investigated in orthopaedic and cardiac surgery, while remain scarce in thoracic and abdominal surgery. We will perform an observational cohort study to explore the incidence and potential risk variables of POD in thoracic and abdominal surgery, mainly focusing on some prognostic indicators including age-adjusted Charlson Comorbidity Index (ACCI), Prognostic Nutrition Index (PNI) and Fibrinogen to Albumin Ratio (FAR). In addition, we will further develop a predictive model based on related data to provide a novel method for preventing POD.Methods and analysisA single-centre observational study is conducted among patients aged ≥60 years old undergoing thoracic and abdominal surgery from 28 February 2022 to 31 December 2022. The patients will be divided into POD group and non-POD group following the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Related variables mainly including ACCI, PNI and FAR will be analysed by univariate and multivariate logistic regression analyses. Besides, a predictive model will be established according to associated risk factors, and the receiver operating characteristic curve will be used to further evaluate the accuracy of the predictive model.Ethics and disseminationThe study has been approved by the Medical Ethics Committee of Hebei General Hospital (approval number 2022021) and will intend to be published in peer-reviewed journals.Trial registration numberChinese Clinical Trial Registry (ChiCTR2200057126).

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Section: Discussionmentioning

confidence: 99%

Clinical risk analysis of postoperative delirium in elderly patients undergoing thoracic and abdominal surgery: study protocol of a single-centre observational cohort study

Liu

et al. 2022

BMJ Open

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“…To summarize, actions to avoid or reduce delirium incidence can be divided into three categories: preoperative, intraoperative, and postoperative strategies (Table 2) [57][58][59][60][61][62][63][64][65][66]. Due to the paucity of evidence, the actual guidelines suggest avoiding pharmacological approaches as first-line therapy both in non-intensive and intensive care settings [67][68][69].…”

Section: Perioperative Management Of Deliriummentioning

confidence: 99%

Delirium in Older Adults: What a Surgeon Needs to Know

et al. 2022

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Delirium remains a challenging clinical problem in hospitalized older adults, especially for postoperative patients. This complication, with a high risk of postoperative mortality and an increased length of stay, frequently occurs in older adult patients. This brief narrative paper aims to review the recent literature regarding delirium and its most recent update. We also offer physicians a brief and essential clinical practice guide to managing this acute and common disease.

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“…Currently, treatment options for POD do not appear to reduce related mortality and morbidity ( Méndez-Martínez et al, 2021 ). It is essential for clinicians to appropriately adjust perioperative care plans for primary prevention.…”

Section: Introductionmentioning

confidence: 99%

Transcutaneous electrical acupoint stimulation for the prevention of postoperative delirium in elderly surgical patients: A systematic review and meta-analysis

Huang

Liang

Chen

et al. 2023

Front. Aging Neurosci.

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ObjectiveThis systematic review and meta-analysis aimed to evaluate the preventive effect of transcutaneous electrical acupoint stimulation on postoperative delirium in elderly surgical patients.MethodsPubMed, CENTRAL, China National Knowledge Infrastructure, and WanFang databases were searched for randomized controlled trials regarding the effect of transcutaneous electrical acupoint stimulation on preventing postoperative delirium in elderly patients undergoing any type of surgery. The primary outcome was the incidence of postoperative delirium. The secondary outcome was the duration of postoperative delirium. All analyses were conducted using RevMan 5.3 and Stata 13.0 software.ResultsTwelve trials with 991 participants were included, and most of them were at high/unclear risk of bias. Meta-analysis showed transcutaneous electrical acupoint stimulation could reduce the incidence of postoperative delirium (RR = 0.40, 95%CI = 0.29 to 0.55, p < 0.00001) and shorten the duration of postoperative delirium (MD = –0.97 days, 95%CI = −1.72 to −0.22, p = 0.01). Subgroup analyses demonstrated that transcutaneous electrical acupoint stimulation reduced the incidence of postoperative delirium in elderly patients undergoing orthopedic surgery and thoracic surgery, but not digestive surgery; transcutaneous electrical acupoint stimulation with dilatational wave and with continuous wave were both beneficial; and transcutaneous electrical acupoint stimulation was favored when compared to blank and sham control.ConclusionTranscutaneous electrical acupoint stimulation could reduce the incidence of postoperative delirium and shorten the duration of postoperative delirium in elderly surgical patients. The findings should be interpreted with caution due to weak evidence. High-quality, large sample, and multi-center trials are needed to further confirm the preliminary findings.Systematic review registration: https://inplasy.com/inplasy-2022-7-0096/, identifier: INPLASY202270096.

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Related Factors and Treatment of Postoperative Delirium in Old Adult Patients: An Integrative Review

Cited by 10 publications

References 96 publications

Clinical risk analysis of postoperative delirium in elderly patients undergoing thoracic and abdominal surgery: study protocol of a single-centre observational cohort study

Clinical risk analysis of postoperative delirium in elderly patients undergoing thoracic and abdominal surgery: study protocol of a single-centre observational cohort study

Delirium in Older Adults: What a Surgeon Needs to Know

Transcutaneous electrical acupoint stimulation for the prevention of postoperative delirium in elderly surgical patients: A systematic review and meta-analysis

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