Korean J Anesthesiol.
2023 Oct;76(5):490-500. 10.4097/kja.23126.
Effects of early postoperative neurocognitive disorders on clinically relevant outcomes: a meta-analysis
- Likhvantsev VV
1,2 - Landoni G3,4
- Berikashvili LB1,5
- Ermokhina NV1
- Yadgarov MY1
- Kotani Y3,4,6
- Kadantseva KK1,7
- Makarevich DM8
- Grechko AV9
- Affiliations
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- 1Department of Clinical Trials, V. Negovsky Reanimatology Research Institute, Moscow, Russia
- 2Department of Anesthesiology and Resuscitation, First Moscow State Medical University, Moscow, Russia
- 3Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- 4School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- 5Department of Anesthesiology and Resuscitation, Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
- 6Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan
- 7Department of Anesthesiology and Resuscitation, A. Loginov Moscow Clinical Scientific Center, Moscow, Russia
- 8Department of Anesthesiology and Resuscitation, V. Demikhov Municipal Hospital №68, Moscow, Russia
- 9Department of Intensive Care Medicine, Federal Research and Clinical Center of Reanimatology and Rehabilitology, Moscow, Russia
- KMID: 2548313
- DOI: http://doi.org/10.4097/kja.23126
Abstract
- Background
Early postoperative neurocognitive disorders (ePND), include both emergence delirium, which is defined as very early onset postoperative delirium, and emergence agitation, defined as motor arousal. Although research on anesthesia emergence is limited, ePND are likely associated with unfavorable outcomes. This meta-analysis assessed the effect of ePND on clinically relevant outcomes.
Methods
A systematic search of studies published between 2002 and 2022 on MEDLINE, PubMed, Google Scholar, and the Cochrane Library was performed. Studies that included adults with emergence agitation and/or delirium and reported at least one of the following outcomes: mortality, postoperative delirium, length of post-anesthesia care unit stay, or length of hospital stay were included. The internal validity, risk of bias, and certainty of the evidence were assessed.
Results
A total of 16,028 patients from 21 prospective observational studies and one case-control retrospective study were included in this meta-analysis. The occurrence rate of ePND was 13% (data excluding the case-control study). The mortality rate was 2.4% in patients with ePND vs. 1.2% in the normal emergence group (risk ratio [RR]: 2.6, P = 0.01, very low quality of evidence). Postoperative delirium occurred in 29% of patients with ePND and 4.5% of patients with normal emergence (RR: 9.5, P < 0.001, I2 = 93%). Patients with ePND had a prolonged length of post-anesthesia care unit stay (P = 0.004) and length of hospital stay (P < 0.001).
Conclusions
This meta-analysis suggests that ePND are associated with twice the risk of mortality and a 9-fold increased risk of postoperative delirium.
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