TY - JOUR
T1 - Multi-disciplinary and pharmacological interventions to reduce post-operative delirium in elderly patients
T2 - A systematic review and meta-analysis
AU - Igwe, Ezinne O.
AU - Nealon, Jessica
AU - Mohammed, Mohammed
AU - Hickey, Blake
AU - Chou, Kuei Ru
AU - Chen, Joyce K.
AU - Traynor, Victoria
N1 - Copyright © 2020 Elsevier Inc. All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - Study objective: An estimated 80% of older people undergoing surgery develop postoperative delirium (POD) making them a high-risk group. Research in this area is growing fast but there is no established consensus on strategies for POD prevention or management. A systematic review and meta-analysis were conducted to synthesise data on clinical interventions used to reduce POD among older people undergoing elective and emergency surgery. Methods: A range of database searches generated 336 papers. A total of 25 studies met the inclusion criteria and were assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The studies were undertaken across the world. Results: This review identified a range of intervention approaches: comparisons between anaesthetic and sedatives agents, medication-specific interventions and multidisciplinary models of care. Results found more consistencies across multidisciplinary interventions than the pharmacological interventions. In pooled analyses, haloperidol (OR 0.74; 95% CI (confidence interval) 0.44, 1.26) was not statistically significantly associated with reduced POD incidence any more than a placebo. Conclusion: There is a need to implement multidisciplinary interventions, as well as collaboration between clinicians on pre- and postoperative care practices regarding pharmacological interventions to more effectively reduce and manage POD in older people.
AB - Study objective: An estimated 80% of older people undergoing surgery develop postoperative delirium (POD) making them a high-risk group. Research in this area is growing fast but there is no established consensus on strategies for POD prevention or management. A systematic review and meta-analysis were conducted to synthesise data on clinical interventions used to reduce POD among older people undergoing elective and emergency surgery. Methods: A range of database searches generated 336 papers. A total of 25 studies met the inclusion criteria and were assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The studies were undertaken across the world. Results: This review identified a range of intervention approaches: comparisons between anaesthetic and sedatives agents, medication-specific interventions and multidisciplinary models of care. Results found more consistencies across multidisciplinary interventions than the pharmacological interventions. In pooled analyses, haloperidol (OR 0.74; 95% CI (confidence interval) 0.44, 1.26) was not statistically significantly associated with reduced POD incidence any more than a placebo. Conclusion: There is a need to implement multidisciplinary interventions, as well as collaboration between clinicians on pre- and postoperative care practices regarding pharmacological interventions to more effectively reduce and manage POD in older people.
KW - Guidelines
KW - Meta-analysis
KW - Office-based anaesthesia
KW - Pharmacology in older people
KW - Postoperative delirium
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U2 - 10.1016/j.jclinane.2020.110004
DO - 10.1016/j.jclinane.2020.110004
M3 - Review article
C2 - 32768990
AN - SCOPUS:85088951669
SN - 0952-8180
VL - 67
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
M1 - 110004
ER -