Abstract
Delirium is a frequent occurring complication in surgical patients. Nevertheless, a scientific work-up of the clinical relevance of delirium after intracranial surgery is lacking. We conducted a systematic review (CRD42020166656) to evaluate the current diagnostic work-up, incidence, risk factors and health outcomes of delirium in this population. Five databases (Embase, Medline, Web of Science, PsycINFO, Cochrane Central) were searched from inception through March 31st, 2021. Twenty-four studies (5589 patients) were included for qualitative analysis and twenty-one studies for quantitative analysis (5083 patients). Validated delirium screening tools were used in 70% of the studies, consisting of the Confusion Assessment Method (intensive care unit) (45%), Delirium Observation Screening Scale (5%), Intensive Care Delirium Screening Checklist (10%), Neelon and Champagne Confusion Scale (5%) and Nursing Delirium Screening Scale (5%). Incidence of post-operative delirium after intracranial surgery was 19%, ranging from 12 to 26% caused by variation in clinical features and delirium assessment methods. Meta-regression for age and gender did not show a correlation with delirium. We present an overview of risk factors and health outcomes associated with the onset of delirium. Our review highlights the need of future research on delirium in neurosurgery, which should focus on optimizing diagnosis and assessing prognostic significance and management.
Highlights
Delirium is characterized by a temporary decline in the patient’s mental status affecting attention, awareness, cognition, language and/or visuospatial ability, [1] caused by dysregulation of neuronal activity [2]
We have decided to only include patients that underwent intracranial surgery to assess delirium as a post-operative complication to improve the uniformity of the study population, which is a minor adaptation from the original protocol as registered in PROSPERO
Full-text screening required a clear number of patients that underwent intracranial surgery and reproducible diagnosis of delirium, with or without the use of a validated tool
Summary
Delirium is characterized by a temporary decline in the patient’s mental status affecting attention, awareness, cognition, language and/or visuospatial ability, [1] caused by dysregulation of neuronal activity [2]. Delirium in the neurosurgical population has been under-investigated. Delirium is considered a severe complication in other populations, being a traumatic experience for patients and contributing to prolonged hospital stay, higher risk for re-operation, mortality and cognitive decline [7,8,9,10]. These consequences of delirium led to increased research on delirium, including in the neurosurgical population [5, 7, 9, 11]
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