Table 2 Characteristics of included studies evaluating different perioperative procedures and drugs
Subcategory | Study | Definition delirium | Evaluation timing (d) | Surgery type | Intervention (I1 vs. I2) | Gender (F/M) | Age (y) | Score | Incidence (n/total) (%) | P value | Delirium duration or severity | Hospital stay (d) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Controlled hypotension | Williams-Russo, 1999 [23] | DSM- III | POD 1-7 or discharge | Orthopedic | MAP 45-55 vs. MAP 55-70 mmHg | I1: 51/66 I2: 65/53 | I1: 72 ± 7 I2: 72 ± 8 | 10 | I1: 10/117 (8.5%) I2: 5/118 (4.2%) | 0.177 |  | N/A |
|  | Berggren, 1987 [17] | DSM- III | POD 1,7 | Orthopedic | Neuraxial (epidural) vs. general anesthesia (halothane) | I1: 22/7 I2: 24/4 | I1: 78 ± 8 I2: 77 ± 7 | 5 | I1: 11/26 (42.3%) I2: 9/26 (34.6%) | 0.569 |  | N/A, NS |
Anesthesia type (neuraxial or general anesthesia) | Williams-Russo, 1995 [20] | DSM- III | POD 1-7 | Orthopedic | Neuraxial (epidural) vs. general anesthesia (isoflurane) | I1: 71/63 I2: 70/58 | I1: 69 I2: 69 | 9 | I1: 16/134 (11.9%) I2: 12/128 (9.4%) | 0.502 |  | I1: 12.7 ± 5.3 I2: 12.7 ± 4.3 |
|  | Kudoh, 2004 [27] | CAM | POD 1-7 | Orthopedic | Neuraxial (epidural) vs. general anesthesia (propofol) | I1: 69/6 I2: 66/9 | I1: 76 ± 4 I2: 75 ± 4 | 8 | I1: 5/75 (6.7%) I2: 12/75 (16%) | 0.070 |  | N/A |
| Â | Papaioannou, 2005 [31] | DSM-III | POD 1-3 | Abdominal | Neuraxial (some patients used propofol for sedation) vs. general anesthesia | I1: 10/18 I2: 7/12 | > 60 | 7 | I1: 6/28 (21.4%) I2: 3/19 (15.8%) | 0.720 | Â | N/A |
Sedation depth during spinal anesthesia | Sieber, 2010 [47] | CAM | POD 1-discharge | Orthopedic | Deep sedation (BIS ≈ 50) vs. light sedation (BIS ≥ 80) | I1: 43/14 I2: 40/17 | I1: 82 ± 7 I2: 81 ± 8 | 9 | I1: 23/57 (40.4%) I2: 11/57 (19.3%) | 0.014 | Duration ( P = 0.01): I1: 1.4 ± 4.0 days I2: 0.5 ± 1.5 days Duration in patients with delirium ( P = 0.77): I1: 3.4 ± 5.7 days I2: 2.8 ± 2.3 days | I1: 4.5 ± 2.3 I2: 4.7 ± 3.1 |
|  | Nishikawa, 2004 [28] | DSM-III, DRS | POD 1-3 | Abdominal | Epidural anesthesia/propofol vs. epidural anesthesia/sevoflurane | I1: 12/13 I2: 13/12 | I1: 71 ± 8 I2: 71 ± 7 | 7 | I1: 4/25 (16%) I2: 0/25 (0) | 0.110 | Severity based on DRS ( P = 0.002): I1: 6 ± 3 I2: 2 ± 1 | N/A |
Anesthesia (anesthetics) | Hudetz, 2009 [40] | DSM-IV | POD 1-5 | Cardiovascular | Additional ketamine (0.5 mg/kg, iv, single bolus) vs. standard | N/A | I1: 68 ± 8 I2: 60 ± 8 | 8 | I1: 1/29 (3.4%) I2: 9/29 (31.0%) | 0.012 |  | I1: 8 ± 4 I2: 7 ± 3 |
|  | Royse, 2011 [51] | CAM | POD 1 | Cardiovascular | propofol vs. desflurane | I1: 9/80 I2: 18/73 | I1: 64 ± 11 I2: 62 ± 10 | 8 | I1: 7/89 (7.9%) I2: 12/92 (13.0%) | 0.245 |  | I1: 7 ± 2 I2: 6 ± 2 |
|  | Leung, 2006 [34] | CAM | POD 1-2 | Non-cardiovascular | Additional N2O vs. standard | I1: 62/52 I2: 51/63 | I1: 74 ± 6 I2: 74 ± 6 | 6 | I1: 44/105 (41.9%) I2: 46/105 (43.8%) | 0.780 |  | I1: 5.4 ± 3.5 I2: 4.8 ± 2.9 |
Postoperative analgesia (epidural or intravenous analgesia) | Williams-Russo, 1992 [19] | DSM- III | POD 1-7 | Orthopedic | Epidural analgesia vs. Intravenous analgesia | N/A | 68 ± 7 | 7 | I1: 10/26 (38.5%) I2: 11/25 (44%) | 0.688 |  | N/A |
|  | Mann, 2000 [24] | DSM-III | POD 1- discharge | Abdominal | Epidural analgesia vs. Intravenous analgesia | I1: 15/20 I2: 17/18 | I1: 76 ± 6 I2: 77 ± 5 | 8 | I1: 8/31 (25.8%) I2: 8/33 (24.2%) | 0.885 |  | I1: 10.5 ± 5 I2: 11.5 ± 6 |
|  | Beaussier, 2006 [32] | CAM | POD 1- discharge | Abdominal | Epidural analgesia vs. Intravenous analgesia | I1: 11/15 I2: 14/12 | I1: 78 ± 5 I2: 77 ± 5 | 9 | I1: 9/26 (34.6%) I2: 10/26 (38.5%) | 0.773 |  | I1: 7.9 ± 2 I2: 8.4 ± 1.7 |
Postoperative analgesia (additional regional analgesia or standard treatment) | Mouzopoulos, 2009 [43] | DSM-IV, CAM, DRS | POD 1- discharge | Orthopedic | Additional fascia iliaca compartment block (0.25% bupivacaine, 0.3 mL/kg) vs. standard treatment | I1: 78/24 I2: 76/29 | I1: 72 ± 4 I2: 73 ± 4 | 7 | I1: 11/102 (10.8%) I2: 25/105 (23.8%) | < 0.001 | Duration ( P < 0.001): I1: 5.22 ± 4.28 days I2: 10.97 ± 7.16 days Severity based on DRS ( P < 0.001): I1: 14.34 ± 3.6 I2: 18.61 ± 3.4 | N/A |
Postoperative analgesia (morphine or placebo) | Musclow, 2012 [53] | NEECHAM | POD 1- discharge | Orthopedic | Morphine (30 mg, bid, po) (POD1-3) vs. placebo | I1: 78/24 I2: 76/29 | I1: 67 ± 4 I2: 64 ± 11 | 11 | I1: 10/97 (10.3%) I2: 3/93 (3.2%) | 0.082 | Severity based on NEECHAM ( P = 0.02): I1: 28.70 ± 1.82 I2: 29.14 ± 0.61 | N/A |
Postoperative sedation (alpha-2 adrenergic receptor agonists or other sedatives) | Maldonado, 2009 [41] | DSM-IV | POD 1-3 | Cardiovascular | Dexmedetomidine (loading dose: 0.4 μg/kg, maintenance drip of 0.2-0.7 μg/kg/hour) vs. propofol (25-75 μg/kg/min) vs. midazolam (0.5-2 mg/hour) | I1: 14/26 I2: 16/22 I3: 13/27 | I1: 55 ± 16 I2: 58 ± 18 I3: 60 ± 16 | 8 | I1: 4/40 (10%) I2: 16/36 (44.4%) I3: 17/40 (42.5%) | < 0.001 | Duration in patients with delirium ( P = 0.82): I1: 2.0 ± 0 days I2: 3.0 ± 3.1 days I3: 5.4 ± 6.6 days | I1: 7.1 ± 1.9 I2: 8.2 ± 3.8 I3: 8.9 ± 4.7 |
|  | Shehabi, 2009 [44] | CAM-ICU | POD 1-5 | Cardiovascular | Dexmedetomidine (0.1-0.7 μg/kg/hour) vs. morphine (10-70 μg/kg/hour) | I1: 38/114 I2: 36/111 | I1: 72 ± 8 I2: 71 ± 8 | 11 | I1: 13/152 (8.6%) I2: 22/147 (15.0%) | 0.031 | Duration ( P = 0.032): I1: 2 ± 4 days I2: 5 ± 8 days | I1: 8 ± 3 I2: 8 ± 3 |
|  | Rubino, 2010 [46] | DSM-IV, DDS | 30 minutes after weaning | Cardiovascular | Additional clonidine (loading dose: 0.5 μg/kg, maintenance drip of 1-2 μg/kg/hour) vs. standard | I2: 5/10 I2: 7/8 | I1: 64 ± 9 I2: 61 ± 6 | 8 | I1: 6/15 (40%) I2: 5/15 (30%) | 0.705 | Severity based on DDS ( P < 0.001): I1: 0.6 ± 0.7 I2: 1.8 ± 0.8 | N/A |