Preventative interventions for postoperative delirium after intraabdominal surgery – A systematic review and meta-analysis of randomized trials - 12/04/25
, K. Thorhauge a, b, e, C.L. Petri a, b, M.T. Madsen c, d, e, J. Burcharth a, b, eStructured Abstract |
Background |
Postoperative delirium (POD) is a significant complication associated with extended hospital stays, increased healthcare costs, and heightened morbidity and mortality. With an aging population, the incidence of POD is expected to rise, making the development of effective prevention strategies critical. This study aimed to evaluate the effectiveness of preventive interventions in reducing POD after intraabdominal surgery.
Methods |
A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases including MEDLINE, Embase, and The Cochrane Library were searched for randomized controlled trials (RCTs) that examined preventive strategies for POD in adult patients undergoing intraabdominal surgery. The primary outcome was the incidence of POD, analyzed using a random-effects meta-analysis.
Results |
Sixteen RCTs involving 4060 participants were included. Preventive interventions reduced the risk of POD by 49 % (RR: 0.51; 95 % CI: 0.36 to 0.73; I 2 = 61.2 %). No significant effects were observed on secondary outcomes such as 30-day and 180-day mortality or length of hospital stay. Subgroup analyses showed a more pronounced effect in laparoscopic surgeries and smaller trials with higher risk of bias.
Conclusions |
Preventive interventions are effective in reducing the incidence of POD after intraabdominal surgery. These findings highlight the importance of incorporating standardized screening and intervention protocols to improve surgical outcomes, especially in high-risk populations. Further research should focus on refining prevention strategies and exploring the underlying mechanisms of POD.
Le texte complet de cet article est disponible en PDF.Study Highlights |
• | We conducted an exhaustive search of PubMed, Ovid MEDLINE, and The Cochrane Library up to January 3, 2024, adhering to PRISMA guidelines and Cochrane recommendations. |
• | Our meta-analysis includes data from 16 RCTs involving 4060 participants, which showed a significant 49 % reduction in POD risk with various interventions (RR: 0.51; 95 % CI 0.36 to 0.73; I2 = 61.2 %). These interventions included pharmacologic, bundle-care, and anesthesiological targets. |
• | This manuscript is significant because it provides a comprehensive evaluation of existing preventive strategies for POD, highlighting the importance of early identification and intervention. The systematic review and meta-analysis approach enhances the reliability of the findings, which can inform clinical practice and future research. |
• | We believe this manuscript is well-suited for publication in The American Journal of Surgery due to its clinical relevance and the rigorous methodological approach. The results could be instrumental for surgeons, anesthesiologists, and healthcare providers involved in the peri- and postoperative care of patients undergoing intraabdominal surgery. |
• | Systematic review and meta-analysis of 16 randomized controlled trials (RCTs) on postoperative delirium (POD) prevention after intraabdominal surgery. |
• | Preventive interventions reduced the risk of POD by 49 % (RR: 0.51; 95 % CI: 0.36–0.73). |
• | Laparoscopic surgical approaches showed the most significant reduction in POD risk. |
• | Identified heterogeneity in intervention effects, highlighting the need for standardized protocols. |
• | Calls for future research on emergency surgical settings and high-risk populations. |
Keywords : Postoperative delirium, Intra-abdominal, Surgery, Preventive interventions, Systematic review, Meta-analysis
Plan
Vol 243
Article 116245- mai 2025 Retour au numéro
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