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Preview Project: Preoperative prognostic factors associated with postoperative delirium in older people undergoing surgery: a systematic review and individual patient data meta-analysis

Project Status: Active

Project Creator: Katie

Project ID: 221

Reviewers: 19

Test Set: 100

Upload Documents: 0

Title and Abstract: 0

Full Text: 0

Systematic Review Information:

Study Goal

BACKGROUND: Elderly patients undergoing surgery are more vulnerable to adverse postoperative outcomes due to advanced age, frailty, and concurrent medical conditions. Postoperative delirium, in particular, is frequently encountered in older surgical patients and is associated with increased morbidity and mortality. Since there is no simple and effective way to treat Postoperative delirium once it has occurred, prevention may be the key. Previous research has shown that delirium may be partially prevented using multicomponent risk intervention strategies. These prophylactic measures are best targeted at high-risk individuals. DESCRIPTION OF THE CONDITION: Postoperative delirium is recognized as the most common postoperative complication in the elderly, occurring in 1 to 50% of older patients after major surgical procedures. Postoperative delirium usually occurs in the early postoperative period and is defined as an acute neuropsychiatric disorder characterised by fluctuating disturbances in attention, awareness, and cognition. It is associated with postoperative cognitive decline and long-term dementia, poor functional recovery, prolonged hospitalization, increased nursing home admission, and increased mortality. WHY IT IS IMPORTANT TO DO THIS REVIEW: Early identification of patients at risk for delirium is essential because adequate well-timed interventions could reduce the occurrence of delirium and the related detrimental outcome. Several pre- and postoperative risk prediction models, using multiple risk factors for postoperative delirium have been developed through the years, however, these models target highly specific populations and none are currently used in the daily practice. Furthermore, in 2018, The Fifth International Perioperative Neurotoxicity Working Group recommend that all the patients above 65 years of age should be informed of the risk of perioperative neurocognitive disorders and should get a baseline cognitive testing before the operation. OBJECTIVES: To conduct a systematic review on the predictive value of risk factors associated with an increased risk of postoperative delirium in older people undergoing surgery. This systematic review will inform the basis of the first IPD meta-analysis that aims to identify and assess the value of prognostic factors for postoperative delirium in older patients. Full protocol available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666505

Study Protocol

13643_2020_Article_1518.pdf - (created on: May 12, 2021, 3:12 p.m.) Download

Description of PI and Investigative Team

We are performing an individual participant data (IPD) meta-analysis on pre-operative risk factors of postoperative delirium. Our group consist of world leading researchers and practitioners from McMaster University and anesthesiologists from Canada, USA, Switzerland, and the Netherlands.

Offerings to Reviewers

Potential authorship
Letter of reference
Research Experience

Comments & Advice to Reviewers

Join this exciting community collaboration and get involved by helping us answer this important research question. This great networking opportunity will yield one or more publications and potential for involvement in future projects. To qualify for group authorship, it is expected that participants in the Crowdsourcing event will complete a minimum of 500-1000 assessments at title and abstract level, and 50-100 assessments at full text level.

How can you help

Contribute to Systematic Review

If the investigator has provided you with a "SECRET KEY" word, please use the Apply with Key button below. If you were not given a secret key word, please complete the test set using the Start Test Set button below. (The Start Test Set button will only appear if the project creator has created one)

Inclusion Criteria	Exclusion Criteria
We will include studies that meet all of the following criteria: Non-randomized studies, case-control studies, retrospective and prospective cohorts, single-arm longitudinal studies (Note: A secondary analysis of an RCT will be considered a cohort study) Study that enrolled older adults (≥ 50 years) undergoing elective, emergency, or urgent surgery Study assesses preoperative risk factors for postoperative delirium Study measures the rate or risk of delirium (up to 1-week post-surgery) Study used validated delirium assessment tool/criteria by a trained individual (EXAMPLES OF eligible tools/instruments are: the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, Confusion Assessment Method (CAM), CAM-ICU, or 3D- CAM, Delirium Observation Screening (DOS) scale, Delirium Symptom Interview (DSI), Nursing Delirium Symptom Checklist (NuDESC), Delirium Rating Scale-Revised-98 or any combination of these tools Study is published in English	We will exclude studies that meet any of the following criteria: Study ONLY includes adults <50 years old or children Study does not evaluate post-operative delirium Study does not evaluate preoperative risk factors for postoperative delirium Study that didn’t use a validated tool for diagnosis of postoperative delirium Study that evaluated delirium retrospectively (e.g. postoperative delirium diagnosis done from patient charts – this includes chart review studies and studies that used registry data) Study only addresses delirium tremens (confusion due to withdrawal from alcohol) Study only focused on critically ill patients, ICU delirium, and/or intubated patients (e.g. studies that evaluate postoperative delirium in patients that are unconscious/intubated before the surgery) Study only assessed "incident delirium" (i.e. delirium which develops during a hospital admission or residential stay in long-term care) Study only assessed emergence delirium (i.e. delirium that begins with emergence from anesthesia and continues through the early recovery period) Study that only assessed postoperative delirium more than 7 days post-op Study published in a language other than English We will exclude conference abstracts We will exclude the following study designs: randomized controlled trial (RCT); systematic or scoping review, narrative review, editorial or opinion piece, case study, case series, study protocol that does not present results

Inclusion Criteria

Exclusion Criteria

We will include studies that meet all of the following criteria:
Non-randomized studies, case-control studies, retrospective and prospective cohorts, single-arm longitudinal studies (Note: A secondary analysis of an RCT will be considered a cohort study)
Study that enrolled older adults (≥ 50 years) undergoing elective, emergency, or urgent surgery
Study assesses preoperative risk factors for postoperative delirium
Study measures the rate or risk of delirium (up to 1-week post-surgery)
Study used validated delirium assessment tool/criteria by a trained individual (EXAMPLES OF eligible tools/instruments are: the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, Confusion Assessment Method (CAM), CAM-ICU, or 3D- CAM, Delirium Observation Screening (DOS) scale, Delirium Symptom Interview (DSI), Nursing Delirium Symptom Checklist (NuDESC), Delirium Rating Scale-Revised-98 or any combination of these tools
Study is published in English

We will exclude studies that meet any of the following criteria:
Study ONLY includes adults <50 years old or children
Study does not evaluate post-operative delirium
Study does not evaluate preoperative risk factors for postoperative delirium
Study that didn’t use a validated tool for diagnosis of postoperative delirium
Study that evaluated delirium retrospectively (e.g. postoperative delirium diagnosis done from patient charts – this includes chart review studies and studies that used registry data)
Study only addresses delirium tremens (confusion due to withdrawal from alcohol)
Study only focused on critically ill patients, ICU delirium, and/or intubated patients (e.g. studies that evaluate postoperative delirium in patients that are unconscious/intubated before the surgery)
Study only assessed "incident delirium" (i.e. delirium which develops during a hospital admission or residential stay in long-term care)
Study only assessed emergence delirium (i.e. delirium that begins with emergence from anesthesia and continues through the early recovery period)
Study that only assessed postoperative delirium more than 7 days post-op
Study published in a language other than English
We will exclude conference abstracts
We will exclude the following study designs: randomized controlled trial (RCT); systematic or scoping review, narrative review, editorial or opinion piece, case study, case series, study protocol that does not present results