The incidence of delirium after cardiac surgery in the elderly: protocol for a systematic review and meta-analysis

Abstract

IntroductionDelirium is one of the most common complications after cardiac surgery in the elderly. Future studies aimed at preventing postoperative delirium will need an accurate estimate of incidence. However, there are no available systematic reviews on the incidence, and reports of incidence of postoperative delirium after a cardiac operation vary widely with significant heterogeneity. Therefore, we aim to perform a systematic review and meta-analysis to determine the most accurate incidence possible of postoperative delirium in individuals aged >65 years after cardiac surgery.Methods and analysesWe will undertake a comprehensive literature search among PubMed, EMBASE, the Cochrane Library, PsycINFO and CINAHL, from their inception to January 2017. Prospective cohort and cross sectional studies that described the incidence of delirium will be eligible for inclusion. The primary outcome will be the incidence of delirium. Risk of bias and methodological quality for the included studies will be assessed using a risk of bias tool for prevalence studies and the Cochrane guidelines. Heterogeneity of the estimates across studies will be assessed. Incidence data will be pooled by selective or emergency surgery. This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).Ethics and disseminationThis proposed systematic review and meta-analysis is based on published data, and thus there is no requirement for ethics approval. The study will provide an up to date and accurate incidence of postoperative delirium among the older population after cardiac surgery, which is necessary for future research in this area. The findings of this study will be presented at conferences and disseminated through publication in a peer reviewed journal.Trial registration numberCRD42016047773.

Is Delirium the Cognitive Harbinger of Frailty in Older Adults? A Review about the Existing Evidence

“…Both should be considered as multifactorial health conditions, characterized by multiple risk factors and causation which are not necessarily specific to a given organ system failure. This notion is indirectly confirmed by a growing body of evidence, from cardiology ( 17 , 18 ) to infectious disease medicine ( 19 , 20 ), from oncology ( 21 , 22 ) to anesthesiology ( 23 , 24 ), that these two conditions have a crucial role in clinical and research areas. Both frailty and delirium share many commonalities.…”

Lived experience of patients inICUafter cardiac surgery: A phenomenological study

“…Depending on the methodology, post-CS delirium is diagnosed in 26% to 52% of patients, with some studies reporting percentages as high as 70%. 6,7 In addition, general anaesthesia, cardiopulmonary bypass, and pain could be contributing factors to postoperative complications. 8 Consequently, postoperative complications have been associated with increased resource utilization, morbidity (eg, a prolonged stay in the intensive care unit (ICU) and prolonged hospitalization), and mortality.…”

Incidencia de Delírium en una población de adultos mayores de 65 años hospitalizados en un centro de referencia del Nororiente Colombiano

“…También se asoció estadísticamente con delírium a pacientes con reserva renal y eritrocitaria disminuida (niveles elevados de creatinina, BUN y Hb < 12 gr/dL), situaciones frecuentes en el contexto de la probable condición aguda causante del ingreso o de un estado crónico previo conocido de la comorbilidad propia del paciente, la literatura documenta que, de manera independiente la anemia leve se asocia a mayor dependencia funcional (por menor fuerza muscular y actividad física) y disminución en las funciones cognitivas, características que no solo son predisponentes de delirium sino de mortalidad 33 . La estancia hospitalaria fue mayor en los participantes que desarrollaron delirium, varios estudios muestran esta relación 34,35,36 y por esto los esfuerzos están encaminados en la prevención para reducir las cifras incidentes de delirium no solo en pacientes con condición médica sino quirúrgica 37 .De otro lado, puntajes en el MMSE ≥ 24, índice de Barthel ≥ 60 y un MNA ≥ 12 se comportaron como factores protectores con significancia estadística 27,30,38,39,40,41 .…”