Abstract
BackgroundEarly identification of patients at risk for postoperative delirium is essential because adequate well-timed interventions could reduce the occurrence of delirium and the related detrimental outcomes.MethodsWe will conduct a systematic review and individual patient data (IPD) meta-analysis of prognostic studies evaluating the predictive value of risk factors associated with an increased risk of postoperative delirium in elderly patients undergoing elective surgery. We will identify eligible studies through systematic search of MEDLINE, EMBASE, and CINAHL from their inception to May 2020. Eligible studies will enroll older adults (≥ 50 years) undergoing elective surgery and assess pre-operative prognostic risk factors for delirium and incidence of delirium measured by a trained individual using a validated delirium assessment tool. Pairs of reviewers will, independently and in duplicate, screen titles and abstracts of identified citations, review the full texts of potentially eligible studies. We will contact chief investigators of eligible studies requesting to share the IPD to a secured repository. We will use one-stage approach for IPD meta-analysis and will assess certainty of evidence using the GRADE approach.DiscussionSince we are using existing anonymized data, ethical approval is not required for this study. Our results can be used to guide clinical decisions about the most efficient way to prevent postoperative delirium in elderly patients.Systematic review registrationCRD42020171366.
Highlights
Identification of patients at risk for postoperative delirium is essential because adequate welltimed interventions could reduce the occurrence of delirium and the related detrimental outcomes
Postoperative delirium (POD) [2], in particular, is recognized as the most common postoperative complication in the elderly [3], affecting up to 50% of hospitalized surgical patients, POD typically occurs in the early postoperative period and is defined as an acute neuropsychiatric disorder, characterized by fluctuating disturbances in attention, awareness, and cognition
POD is associated with increased morbidity and mortality [4, 5], postoperative cognitive decline and long-term dementia, poor functional recovery, prolonged hospitalization, and increased nursing home admission [6,7,8]
Summary
Protocol registration and standard reporting We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols checklist when writing this protocol (Additional file 1) [31]. Collection of study-level data and data storage We will contact principal investigators or corresponding authors of eligible studies to inform them about the study and ask if they are willing to share IPD. Those who express an interest in collaboration will be invited to read the protocol and to discuss the requirements for data sharing. Randomeffects linear regression fitted with mixed or logistic two-level regression model (with patients nested within studies) will be used in the one-stage approach (using ipdforst package in Stata) In this approach, the IPD from all studies will be pooled in a single step, while accounting for clustering of patients within studies.
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