Effect Of Perioperative Precautionary Measures For Postoperative Delirium:a Meta-analysis

BackgroundPostoperative delirium not only increases the medical burden,but also causes serious adverse consequences to the prognosis of patients and their families.Studies have shown that some cases of delirium can be avoided by early intervention,but there is no clear evidence that any of these measures can effectively prevent the occurrence of postoperative delirium.ObjectiveThe purpose of this article is to evaluate the existing preventive measures for postoperative delirium and effectiveness.MethodsWe searched English literature and literature references from Pubmed,OVID(Embase and MEDLINE),Web of Science and the Cochrane Library before January 2020.We selected qualified randomized controlled trials based on the inclusion and exclusion criteria.Data extraction and methodological quality assessment were performed according to a pre-designed data extraction form and scoring system.Meta-analysis of similar interventions was performed.The main outcome was the incidence of postoperative delirium.Other outcome indicators such as duration of delirium and the length of stay in ICU and hospital were also included for analysis.ResultsA total of 63 randomized controlled trials were included in the study,in which the intervention measures included surgical methods,types of anesthesia,anesthetic drugs,analgesic methods,intraoperative blood glucose control,cholinesterase inhibitors,anticonvulsant drugs,antipsychotic drugs,sleep rhythmic regulation and multi-modal nursing.The incidence of postoperative delirium was low in four studies which monitored the depth of anesthesia with BIS during the operation(P <0.0001).Two studies showed that supplementary analgesia can reduce postoperative delirium(P = 0.002).Seventeen studies showed that sedation with an alpha-2 adrenergic receptor agonist can prevent postoperative delirium(P = 0.0006).Six studies have shown that both typical and atypical antipsychotic drugs can help reduce the incidence of postoperative delirium.(P = 0.002).The use of multi-modal nursing during the perioperative period effectively reduced postoperative delirium in six studies(P <0.00001).The duration of delirium was recorded in twenty-three studies,the length of postoperative ICU hospital stay was recorded in twenty-two reaearches,the total length of hospital stay was recorded in twenty-seven articles and the postoperative stay was recorded in six studies.Effective preventions can reduce delirium duration,postoperative hospital stay and total hospital stay in noncardiac surgery patients.For cardiac surgery,effective prevention measures only reduce the length of stay in ICU.ConclusionThe results of this meta-analysis support intraoperative monitoring of BIS,supplemental analgesia,alpha-2 adrenergic agonists,antipsychotic drugs and multimodal care to prevent postoperative delirium.