Key result
Older age (MD 4.314) and lower clock drawing test scores (MD -2.443) were significantly associated with an increased risk of incident post-operative delirium in patients undergoing urological surgery.
Why the study?
Post-operative delirium is an under-researched surgical complication, and urological surgery patients may face high risk due to older age and procedural triggers.
What are the risk factors for incident post-operative delirium in urological patients?
Meta-Analysis (n=1,937)
What are the risk factors for incident post-operative delirium in urological patients?
Mean Difference: 4.314 (95% CI 1.597–7.032)
p-value: p=0.002
Age and poor performance on the clock drawing test are significant risk factors for post-operative delirium in urological patients, though current evidence is limited by high risk of bias and heterogeneity.
Identifies age and other risk factors for POD after urological surgery; leaves open prospective validation and prevention trials.
BACKGROUND: Post-operative delirium is an important, yet under-researched complication of surgery. Patients undergoing urological surgery may be at especially high risk of POD, as they are often older, and interventions can be associated with conditions that trigger delirium. The main aim of this systematic review was to evaluate the available evidence for risk factors in this patient group. METHODS: Five databases were searched (MEDLINE, Web of Science, EMBASE, CINAHL and PsychInfo) between January 1987 and June 2019. The Newcastle-Ottawa Scale was used to assess for risk of bias. Pooled odds ratio or mean difference (MD) for individual risk factors were estimated using the Mantel-Haenzel and inverse variance methods. RESULTS: Seven articles met the inclusion criteria, giving a total population of 1937. The incidence of POD ranged from 5 to 29%. Three studies were deemed low risk of bias and four at a high risk of bias. Nine risk factors were suitable for meta-analysis, with age (MD 4.314 95% CI 1.597, 7.032 p = 0.002) and the clock drawing test (MD - 2.443 95% CI - 3.029, - 1.857 p < 0.001) having a statistically significant association with POD in pooled analyses. CONCLUSION: Delirium is common in urological patients. This review has identified a lack of studies in this surgical population, with wide heterogeneity and high risk of bias. It also highlights a number of potential risk factors for post-operative delirium, of which some are modifiable. However, the strength of evidence is weak at present and so future research should focus on assessing comparable risk factors in this patient group in order to inform future clinical practice. Review registration The review protocol was prospectively registered with the PROSPERO database (reference CRD42017054613).
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Sanyaolu et al. (2020) conducted a meta-analysis in Post-operative delirium (n=1,937). Older age vs. Younger age was evaluated on Incident post-operative delirium (MD 4.314, 95% CI 1.597, 7.032, p=0.002). Older age (MD 4.314) and lower clock drawing test scores (MD -2.443) were significantly associated with an increased risk of incident post-operative delirium in patients undergoing urological surgery.
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