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Table 2 Characteristics of included studies evaluating different perioperative procedures and drugs

From: Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials

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
  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   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
  1. N/A, not available; NS, not significant; POD, postoperative day; DDS, Delirium Detection Score; DSM, Diagnostic and Statistical Manual of Mental Disorders; CAM, Confusion Assessment Method; DRS, Delirium Rating Scale.