The effects of early postoperative neurocognitive disorders on clinically relevant outcomes: a meta-analysis

• Published in: Korean journal of anesthesiology Vol. 76; no. 5; pp. 490 - 500
• Main Authors: Likhvantsev, Valery V, Landoni, Giovanni, Berikashvili, Levan B, Ermokhina, Nadezhda V, Yadgarov, Mikhail Ya, Kotani, Yuki, Kadantseva, Kristina K, Makarevich, Dmitry M, Grechko, Andrey V
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Anesthesiologists 01.10.2023; 대한마취통증의학회
• Subjects: anesthesia; Clinical; delirium; emergence delirium; mortality; neurocognitive disorders; psychomotor agitation; 마취과학; mortality; emergence delirium; postoperative delirium; emergence agitation; early postoperative neurocognitive disorders; anesthesia
• ISSN: 2005-6419; 2005-7563
• DOI: 10.4097/kja.23126

Early postoperative neurocognitive disorders (ePND) include emergence delirium, defined as a very early onset postoperative delirium, and emergence agitation, defined as motor arousal. These ways of anesthesia emergence are poorly investigated although they are probably associated with unfavorable outcomes. This meta-analysis aimed to assess the impact of ePND on clinically relevant outcomes. A systematic search of studies published over the past 20 years was carried out in Medline, PubMed, Google Scholar and Cochrane Library. We included studies describing adults with emergence agitation and/or emergence delirium and reporting at least one of the following: mortality, postoperative delirium, length post-anesthesia care unit or hospital stay. The internal validity, risk of bias, and certainty of evidence were assessed. A total of 16,028 patients from 21 prospective observational studies and 1 case-control retrospective study were included in this meta-analysis. The rate of ePND occurrence was 13 % (from 21 studies excluding the case-control study). The mortality rate was 2.4 % in patients with ePND vs 1.2 % in normal emergence group (RR = 2.6, p = 0.01, very low quality of evidence). Postoperative delirium was 29 % in patients with ePND vs 4.5 % in patients with normal emergence (RR = 9.5, p < 0.001, I2 = 93%). Patients with ePND had a prolonged length of post-anesthesia care unit (p = 0.004) and hospital stay (p < 0.001). This meta-analysis suggests that ePND is associated with a doubled risk of mortality and with a 9-fold increased risk of postoperative delirium.