Risk factors for incident delirium among urological patients: a systematic review and meta-analysis with GRADE summary o
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RESEARCH ARTICLE
Open Access
Risk factors for incident delirium among urological patients: a systematic review and meta‑analysis with GRADE summary of findings L. Sanyaolu1* , A. F. M. Scholz1, I. Mayo1, J. Coode‑Bate2, C. Oldroyd3, B. Carter4,5, T. Quinn3 and J. Hewitt1
Abstract Background: Post-operative delirium is an important, yet under-researched complication of surgery. Patients undergoing urological surgery may be at especially high risk of POD, as they are often older, and interventions can be associated with conditions that trigger delirium. The main aim of this systematic review was to evaluate the available evidence for risk factors in this patient group. Methods: Five databases were searched (MEDLINE, Web of Science, EMBASE, CINAHL and PsychInfo) between Janu‑ ary 1987 and June 2019. The Newcastle–Ottawa Scale was used to assess for risk of bias. Pooled odds ratio or mean difference (MD) for individual risk factors were estimated using the Mantel–Haenzel and inverse variance methods. Results: Seven articles met the inclusion criteria, giving a total population of 1937. The incidence of POD ranged from 5 to 29%. Three studies were deemed low risk of bias and four at a high risk of bias. Nine risk factors were suit‑ able for meta-analysis, with age (MD 4.314 95% CI 1.597, 7.032 p = 0.002) and the clock drawing test (MD − 2.443 95% CI − 3.029, − 1.857 p 3 or ≥ 2 co-mor‑ bidities)
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Mean BMI
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ADL (mean score or functions lost)
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IADL (mean score or functions lost)
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Surgical Operation time (mean or median)
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Blood loss (mean or median)
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Intraoperative hypotension ±
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GA versus regional Anaesthesia
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Alcohol intake (active consumption or excess/abuse)
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Age was described by a variety of methods in the included studies such as mean, median or age range. The results presented represent if increasing age was associated with POD ±Proportion of patients with the exposure/risk factor + increased risk of POD, = no increased risk of POD, ? not clear due to absence of data. See Additional file 1: Table 1 (S1) for full details
MMSE mini mental state examination, CDT clock drawing test, DSI Depression Status Inventory, GDS geriatric depression scale, CCI Charlson Comorbidity Index, BMI body mass index, ADL activities of daily living, IADL Instrumental Activities of Daily Living, GA general anaesthetic, CAGE CAGE questionnaire relates to drinking habits [24]
Table 3 Meta-analyses of risk factors for post-operative delirium Risk factor
Studies/total sample (n/n)
Statistical method
Pooled OR/MD** [95% CI]
Heterogeneity I2 (%)
1. Age*
3/663
IV, Random
4.314 [1.597, 7.032]**
73
2. Male Sex
5/1094
M–H, Random
1.284 [0.421, 3.910]
40
3. BMI
4/1107
IV, Random
0.372 [− 0.121, 0.865]**
0
4. ADL score
3/892
IV, Random
0.061 [− 0.776, 0.898]**
98
5. Pre-op MMSE Score
4/982
IV, Random
96
6. Education
2/448
IV, Random
− 0.476 [− 1.570,
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