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Table 3 Characteristics of included studies evaluating pharmacological, psychological or multicomponent interventions

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)
  Liptzin, 2005 [30] DSM-IV, CAM, DSI POD 7, POD 14 Orthopedic Donepezil (5 mg, po) (pre-1-14+ POD 1-14) vs. placebo I1: 25/14
I2: 21/20
I1: 67 ± 9
I2: 68 ± 9
6 I1: 8/39 (20.5%)
I2: 7/41 (17.1%)
0.694 Duration ( P = 0.12):
I1: 1 ± 0 days
I2: 1.3 ± 1.2 days
I1: 4.4 ± 0.8
I2: 4.2 ± 0.5
  Sampson, 2007 [37] DSI POD 1-4 Orthopedic Donepezil (5 mg, po) (pre- + POD 1-3) vs. placebo I1: 8/11
I2: 6/8
I1: 70 ± 8
I2: 65 ± 11
10 I1: 2/19 (10.5%)
I2: 5/14 (35.7%)
0.106   I1: 9.9 ± 3.2
I2: 12.1 ± 4.1
Cholinesterase inhibitors Marcantonio, 2011 [48] CAM, DSI, MDAS POD 1-discharge; 2, 4, and 6 weeks Orthopedic Donepezil (5 mg, po) (POD 1-30) vs. placebo I1: 5/2
I2: 4/5
I1: 88 ± 5
I2: 87 ± 4
9 I1: 3/7 (42.9%)
I2: 4/9 (44.4%)
1 Severity based on MDAS changes ( P = 0.91):
I1: 1.3 ± 2.5
I2: 1.6 ± 5.2
N/A
  Gamberini, 2009 [39] CAM POD 1-6 Orthopedic Rivastigmine (1.5 mg, tid, po) (pre-1 + POD 1-6) vs. placebo I1: 19/37
I2: 17/40
I1: 74 ± 5
I2: 74 ± 6
10 I1: 18/56 (32.1%)
I2: 17/57 (29.8%)
0.790   I1: 13 ± 6.2
I1: 13 ± 6.2
  Kaneko, 1999 [22] DSM-III-R POD 5 Abdominal Haloperidol (5 mg, iv) (POD 1-5) vs. saline I1: 14/24
I2: 14/26
I1: 72 ± 8
I2: 73 ± 9
5 I1: 4/38 (10.5%)
I2: 13/40 (32.5%)
0.027   N/A
Antipsychotics (typical) Kalisvaart, 2005 [29] DSM-IV, CAM, DRS POD 1-3 Orthopedic Haloperidol (0.5 mg, tid, po) (pre-POD 3) vs. placebo I1: 172/40
I2: 171/47
I1: 79 ± 6
I2: 80 ± 6
11 I1: 32/212 (15.1%)
I2: 36/218 (13.8%)
0.687 Severity in patients with delirium based on DRS ( P < 0.001):
I1: 14.40 ± 3.5
I2: 18.41 ± 4.4
Duration in patients with delirium ( P < 0.001):
I1: 5.41 ± 4.91 days
I2: 11.85 ± 7.56 days
Patients with delirium:
I1: 17.1 ± 11.1
I2: 22.6 ± 16.7
  Wang, 2012 [54] CAM-ICU POD 1-7 Non-cardiovascular Haloperidol (1.7 mg, iv) (POD) vs. saline I1: 84/145
I2: 85/143
I1: 74 ± 6
I2: 74 ± 7
12 I1: 35/229 (15.3%)
I2: 53/228 (23.2%)
0.031   I1: 11.0 ± 0.9
I1: 11.0 ± 0.8
  Larsen, 2010 [45] DSM-III-R, CAM, DRS POD 1-8 or discharge Orthopedic Olanzapine (5 mg, po) (pre- + POD) vs. placebo I1: 94/102
I2: 123/81
I1: 73 ± 6
I2: 74 ± 6
9 I1: 28/196 (14.3%)
I2: 82/204 (40.2%)
< 0.001 Severity based on DRS ( P = 0.02):
I1: 16.44 ± 3.7
I2: 14.5 ± 2.7
Duration ( P = 0.02):
I1: 2.2 ± 1.3 days
I2: 1.6 ± 0.7 days
N/A
Antipsychotics (atypical) Prakanrattana, 2007 [36] CAM-ICU POD 1-discharge Cardiovascular Risperidone (1 mg, sl) (POD) vs. placebo I1: 27/36
I2: 25/38
I1: 61 ± 10
I2: 61 ± 10
12 I1: 7/63 (11.1%)
I2: 20/63 (31.7%)
0.009   I1: 10.5 ± 6.1
I2: 10.3 ± 4.4
  Hakim, 2012 [52] DSM-IV ICU -discharge Cardiovascular Risperidone (0.5 mg, bid, po) (POD until 24 hours after subsidence of subsyndromal delirium or a score of more than 3 on the ICDSC was obtained) vs. placebo I1: 18/33
I2: 14/36
> 65 12 I1: 7/51 (13.7%)
I2: 17/50 (34%)
0.031 Duration in patients with delirium ( P = 0.669):
I1: 3 ± 1.5 days
I2: 3 ± 0.8 days
I1: 6 ± 1.5
I2: 6 ± 2.3
  Leung, 2006 [33] CAM POD 1-3 Orthopedic Gabapentin (900 mg, po) (pre- + POD 1-3) vs. placebo I1: 5/4
I2: 5/7
I1: 57 ± 10
I2: 61 ± 11
10 I1: 0/9 (0)
I2: 5/12 (41.7%)
0.045   N/A
Anticonvulsants Pesonen, 2011 [50] CAM-ICU POD 1-5 Abdominal Pregabalin (150 mg, po) (pre- + POD 1-5) vs. placebo I1: 14/21
I2: 19/16
I1: 80 ± 11
I2: 80 ± 12
10 N/A N/A Severity based on CAM-ICU ( P = 0.04):
I1: 24 ± 8
I2: 21 ± 19
N/A
Sleep restoration (diazepam/flunitrazepam/pethidine) Aizawa, 2002 [26] DSM-IV POD 1-7 Abdominal Diazepam (0.1 mg/kg, im)/flunitrazepam (0.04 mg/kg, iv)/pethidine (1 mg/kg, iv) (POD 1-3) vs. standard I1: 5/15
I2: 9/11
I1: 76 ± 5
I2: 76 ± 4
8 I1: 1/20 (5%)
I2: 7/20 (35%)
0.023   I1: 25.6 ± 9.4
I2: 29.9 ± 6.2
Sleep restoration (Bright light) Taguchi, 2007 [38] NEECHAM POD 1-5 Thoracic Bright light (2 hours per day; morning; 5000 lx) vs. standard I1: 0/6
I2: 0/5
I1: 56 ± 14
I2: 59 ± 14
7 I1: 1/6 (16.7%)
I2: 2/5 (40%)
0.545 Severity based on NEECHAM ( P = 0.014):
I1: 6.7 ± 0.7
I2: 21.1 ± 7
N/A
  Ono, 2011 [49] NEECHAM, DSM-IV POD 1-6 Thoracic Bright light (POD2-5; 2 hours per day; morning; 2500-5000 lx) vs. standard I1: 0/6
I2: 0/5
I1: 63 ± 10
I2: 64 ± 8
6 I1: 1/10 (10%)
I2: 5/12 (41.7%)
0.162   I1: 24.8 ± 3.9
I2: 24.8 ± 4.0
Psychological interventions Schindler, 1989 [18] DSM-III discharge Cardiovascular Daily psychiatric intervention vs. standard I1: 13/3
I2: 13/4
I1: 58 ± 8
I1: 61 ± 6
3 I1: 0/17 (0)
I2: 2/16 (12.5%)
0.227   I1: 15.7 ± 5
I2: 18.7 ± 6
Music McCaffrey, 2009 [42] NEECHAM POD 1-3 Orthopedic Music vs. standard I1: 7/4
I2: 7/4
I1: 75 ± 5
I1: 76 ± 6
6 N/A N/A Severity based on NEECHAM ( P = 0.000):
I1: 24 ± 0.97
I2: 22.5 ± 1.22
N/A
Multi-component interventions Marcantonio, 2001 [25] CAM POD 1-discharge Orthopedic Geriatrics consultation (a geriatrician made daily visits for the duration of the hospitalization and made targeted recommendations based on a structured protocol including 10 modules) vs. standard I1: 49/13
I2: 50/14
I1: 78 ± 8
I2: 80 ± 8
9 I1: 20/62 (32.3%)
I2: 32/64 (50%)
0.043 The number of patients with severe delirium ( P = 0.02):
I1: 7/62 (11.3%)
I2: 18/64 (28.1%)
Duration in patients with delirium ( P = 0.72):
I1: 2.9 ± 2 days
I2: 3.1 ± 2.3 days
I1: 5 ± 1.5
I2: 5 ± 1.5
  Lundstrom, 2007 [35] DSM-IV, OBS-scale POD 1-discharge Orthopedic Comprehensive intervention (staff education, team work, individual care planning, prevention and treatment delirium and delirium-related complications) vs. standard I1: 74/28
I2: 74/23
I1: 82 ± 7
I2: 82 ± 6
9 I1: 56/102 (54.9%)
I2: 73/97 (75.3%)
0.003 Duration ( P = 0.009):
I1: 5.0 ± 7.1 days
I2: 10.2 ± 13.3 days
I1: 28 ± 17.9
I2: 38 ± 40.6
H 2 receptor blockers Kim, 1996 [21] DSM-III POD1, discharge Cardiovascular Cimetidine vs. ranitidine I1: 14/39
I2: 17/41
I1: 68 ± 10
I2: 64 ± 11
4 I1: 13/53 (24.5%)
I2: 15/58 (25.9%)
0.872   I1: 8.9 ± 3.9
I2: 8.7 ± 2.9
  1. N/A, not available; POD, postoperative day; pre-, preoperative day; DDS, Delirium Detection Score; DSM, Diagnostic and Statistical Manual of Mental Disorders; CAM, Confusion Assessment Method; OBS, organic brain syndrome; DRS, Delirium Rating Scale; DSI, Delirium Symptom Interview; MDAS, Memorial Delirium Assessment Scale; ICDSC, Intensive Care Delirium Screening Checklist; sl, sublingually; po, orally; im, intramuscularly; iv, intravenously; bid, bis in die; tid, ter in die.