Key result
General anesthesia exposure was significantly associated with an elevated risk of postoperative delirium compared to local anesthesia or conscious sedation in patients undergoing transcatheter aortic valve replacement (OR 1.846).
Why the study?
The study was conducted to assess the association of general anesthesia exposure with the risk of postoperative delirium in patients receiving transcatheter aortic valve replacement.
Does general anesthesia increase the risk of postoperative delirium in adults undergoing transcatheter aortic valve replacement compared to local anesthesia or conscious sedation?
Meta-Analysis (n=10,678)
Does general anesthesia increase the risk of postoperative delirium in adults undergoing transcatheter aortic valve replacement compared to local anesthesia or conscious sedation?
Odds Ratio: 1.846 (95% CI 1.329–2.563)
p-value: p=0.0003
General anesthesia during TAVR is associated with a significantly increased risk of postoperative delirium compared to local anesthesia or conscious sedation, suggesting the need for appropriate prophylactic strategies.
GA may favor regional anesthesia to reduce POD risk; leaves open causal inference from observational data.
The aim of this meta-analysis was to assess the association of general anesthesia (GA) exposure with the risk of POD in this patient population. Databases including Medline, EMBASE, Cochrane library, and Google Scholar were searched from inception to December 2022. Analysis of 17 studies published between 2015 and 2021 involving 10,678 individuals revealed an association of GA exposure with an elevated risk of POD [odd ratio (OR) = 1.846, 95% CI 1.329 to 2.563, p = 0.0003, I2 = 68.4%, 10,678 patients]. Subgroup analysis of the diagnostic methods also demonstrated a positive correlation between GA exposure and POD risk when validated methods were used for POD diagnosis (OR = 2.199, 95% CI 1.46 to 3.31, p = 0.0002). Meta-regression analyses showed no significant impact of age, male proportion, and sample size on the correlation between GA and the risk of POD. The reported overall incidence of POD from the included studies regardless of the type of anesthesia was between 0.8 and 27%. Our meta-analysis showed a pooled incidence of 10.3% (95% CI 7% to 15%). This meta-analysis suggested an association of general anesthesia with an elevated risk of postoperative delirium, implying the necessity of implementing appropriate prophylactic strategies against this complication when general anesthesia was used in this clinical setting.
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Ko et al. (2023) conducted a meta-analysis in Transcatheter aortic valve replacement (TAVR) (n=10,678). General anesthesia vs. Local anesthesia or conscious sedation/monitored anesthesia care was evaluated on Risk of postoperative delirium (POD) (OR 1.846, 95% CI 1.329-2.563, p=0.0003). General anesthesia exposure was significantly associated with an elevated risk of postoperative delirium compared to local anesthesia or conscious sedation in patients undergoing transcatheter aortic valve replacement (OR 1.846).
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