Delirium Rating Research Articles

Predictors of Delirium Development in Older Medical Inpatients: Readily Identifiable Factors at Admission.

Identifying patients at high risk of delirium is crucial to facilitate prevention. Although dementia is the most consistent risk factor across populations, it remains under-diagnosed. Hence understanding other markers of delirium vulnerability on admission is important. We aimed to identify predictors of incident delirium development in older medical inpatients that were readily identifiable at presentation to the emergency department. Medical inpatients of ≥70 years were assessed on admission for delirium using the Revised Delirium Rating Scale (DRS-R98) and those with prevalent delirium were excluded. Consenting non-delirious patients were then assessed daily using the DRS-R98. Data pertaining to multiple baseline delirium risk factors were collected, including pre-morbid dementia. Multivariable logistic regression was used to examine which factors predicted the development of incident delirium. Of 555 patients approached, 184 (33.1%) had prevalent delirium. Following other exclusions, 191 were included in the study and 61 developed incident delirium. Predictors of incident delirium on multivariable analysis, controlling for confounders, were dementia (OR 2.54, 95% CI 1.01-6.43, p = 0.048); Barthel Index score (OR 1.15 for each unit decrease in score, 95% CI 1.06-1.25, p = 0.001), and Modified Cumulative Illness Rating Scale score (OR 1.13 for each unit increase in score, 95% CI 1.05-1.22, p = 0.001). Dementia is a well-known risk factor for delirium; however, it too is under-recognized and on admission can be missed. Conversely, the Barthel Index is a simple and widely used measure of functional ability that may prove useful in stratifying those at risk of in-hospital delirium on admission.

Postoperative Delirium as a Target for Surgical Quality Improvement.

To explore hospital-level variation in postoperative delirium using a multi-institutional data source. Postoperative delirium is closely related to serious morbidity, disability, and death in older adults. Yet, surgeons and hospitals rarely measure delirium rates, which limits quality improvement efforts. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Geriatric Surgery Pilot (2014 to 2015) collects geriatric-specific variables, including postoperative delirium using a standardized definition. Hierarchical logistic regression models, adjusted for case mix [Current Procedural Terminology (CPT) code] and patient risk factors, yielded risk-adjusted and smoothed odds ratios (ORs) for hospital performance. Model performance was assessed with Hosmer-Lemeshow (HL) statistic and c-statistics, and compared across surgical specialties. Twenty thousand two hundred twelve older adults (≥65 years) underwent inpatient operations at 30 hospitals. Postoperative delirium occurred in 2427 patients (12.0%) with variation across specialties, from 4.7% in gynecology to 13.7% in cardiothoracic surgery. Hierarchical modeling with 20 risk factors (HL = 9.423, P = 0.31; c-statistic 0.86) identified 13 hospitals as statistical outliers (5 good, 8 poor performers). Per hospital, the median risk-adjusted delirium rate was 10.4% (range 3.2% to 27.5%). Operation-specific risk and preoperative cognitive impairment (OR 2.9, 95% confidence interval 2.5-3.5) were the strongest predictors. The model performed well across surgical specialties (orthopedic, general surgery, and vascular surgery). Rates of postoperative delirium varied 8.5-fold across hospitals, and can feasibly be measured in surgical quality datasets. The model performed well with 10 to 12 variables and demonstrated applicability across surgical specialties. Such efforts are critical to better tailor quality improvement to older surgical patients.

Impact of a Restraint Management Bundle on Restraint Use in an Intensive Care Unit.

Impact of a Restraint Management Bundle on Restraint Use in an Intensive Care Unit.

Effectiveness of a Multifaceted Delirium Screening, Prevention, and Treatment Initiative on the Rate of Delirium Falls in the Acute Care Setting

Delirium is a potentially modifiable fall risk factor, but few studies address the effects of delirium programs on falls. Beginning in 2011, we implemented a nursing-driven hospitalwide delirium program targeting improvements in risk identification, prevention, detection, and treatment. Over the course of the program, delirium falls decreased from 0.91 to 0.50 per patient day (P = .0002). A decrease in overall falls was also noted (P = .0007).

Delirium in the Acute Phase of Ischemic Stroke: Incidence, Risk Factors, and Effects on Functional Outcome

ObjectiveThe aim of this prospective cohort study was to assess the incidence and risk factors of delirium following acute ischemic stroke, as well as its effects on functional outcome. MethodsTwo hundred and sixty-one patients with acute ischemic stroke were screened for delirium during the first week after admission. Delirium was diagnosed according to the Confusion Assessment Method. If delirium was present, delirium rating scale-revised-98 was used to assess its severity. Neurologic deficits were assessed with the National Institutes of Health Stroke Scale (NIHSS). Brain magnetic resonance imaging assessment quantified the infarction, white matter lesions, and medial temporal lobe atrophy. Functional outcome assessment included the modified Rankin Scale and Lawton Instrumental Activities of Daily Living scale at 3 and 6 months after the index stroke. ResultsThirty-eight (14.6%) patients with acute ischemic stroke developed delirium during the first week of admission. Patients with poststroke delirium (PSD) were older, had higher NIHSS scores on admission, and were more likely to have a previous stroke, an infection, and a left cortical infarct. Furthermore, left cortical infarction, older age, severer neurological deficit and having a previous stroke increased the risk of PSD. PSD was associated with a worse functional outcome. ConclusionThe incidence of delirium was 14.8% in the first week after admission with acute ischemic stroke. Age, having a previous stroke, stroke severity, and left-cortical infarction were independently predictors of PSD. PSD may result in a significantly worse functional outcome.

Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial.

Occurrence of delirium in the ICU is associated with a longer stay in the ICU. To examine whether the use of ramelteon, a melatonin agonist, can prevent delirium and shorten the duration of ICU stay of critically ill patients. A single-center, triple-blinded, randomized placebo-controlled trial. ICU of an academic hospital. Eligible patients were ICU patients who could take medicines orally or through a nasogastric tube during the first 48 hours of admission. The intervention group received ramelteon (8 mg/d), and the control group received placebo (1 g/d of lactose powder) at 20:00 hours every day until discharge from the ICU. A total of 88 subjects were randomized to the ramelteon group (45 subjects) or the placebo group (43 subjects). As the primary endpoint, there was a trend toward decrease in the duration of ICU stay (4.56 d) in the ramelteon group compared with the placebo group (5.86 d) (p = 0.082 and p = 0.028 before and after adjustments). As the secondary endpoints, statistically significant decreases in the occurrence rate (24.4% vs 46.5%; p = 0.044) and duration (0.78 vs 1.40 d; p = 0.048) of delirium were observed in the ramelteon group. The nonintubated patients of the ramelteon group showed statistically significantly fewer awakenings per night and a higher proportion of nights without awakenings. Ramelteon tended to decrease the duration of ICU stay as well as decreased the occurrence rate and duration of delirium statistically significantly.

An assistant workforce to improve screening rates and quality of care for older patients in the emergency department: findings of a pre- post, mixed methods study

BackgroundOlder people who present to the Emergency Department (ED) experience high rates of prevalent and incident delirium. This study aimed to determine whether an assistant workforce in the ED could effectively conduct screening to inform assessment and care planning for older people as well as enhance supportive care activities for prevention of delirium.MethodsUsing a pre-post design, data was collected before and after the introduction of Older Person Technical Assistants (OPTAs) in the ED. OPTA activity was recorded during the intervention period and a medical record audit undertaken prior to and 9 months after implementation.Data were analysed using descriptive statistics for OPTA activities. Weighted Kappa scores were calculated comparing concordance in screening scores between OPTAs and Aged Services Emergency Team Registered Nurses. Changes in the rates of documented screening and supportive care were analysed using Chi-square tests.Focus groups were conducted to explore clinicians’ experiences of the OPTA role.ResultsThree thousand five hundred fourty two people were seen by OPTAs in 4563 ED Presentations between 1st July 2011 and 2012. The reproducibility of all screening tools were found to be high between the OPTAs and the RNs, with Kappas and ICCs generally all above 0.9.The medical record audit showed significant improvement in the rates of documented screening, including cognition from 1.5 to 38% (p < 0.001) and review of pain from 29 to 75% (p < 0.001). Supportive care such as being given fluids or food also improved from 13 to 49% (p < 0.001) and pressure care from 4.8 to 30% (p < 0.001). This was accomplished with no increase in ED length of stay among this age group.Focus group interviews described mixed responses and support for the OPTA role.ConclusionsAn assistant workforce in an ED setting was found to provide comparable screening results and improve the rates of documented screening and supportive care provided to older people with or at risk of developing delirium in the ED. There is a need for a shared philosophy to the care of older people in the ED.Trial registrationAustralian New Zealand Clinical Trials Registration number is ACTRN12617000742370. It was retrospectively registered on 22nd May 2017.

Exploring the Knowledge Structure of Nursing Care for Older Patients With Delirium: Keyword Network Analysis.

Prevention of delirium is considered a critical part of the agenda for patient safety and an indicator of healthcare quality for older patients. As the incidence rate of delirium for older patients has increased in recent years, there has been a significant expansion in knowledge relevant to nursing care. The purposes of this study were to analyze the knowledge structure and trends in nursing care for older adults with delirium based on a keyword network analysis, and to provide a foundation for future research. Data analysis showed that knowledge structure in this area consists of three themes of research: postoperative acute care for older patients with delirium, prevention of delirium for older patients in intensive care units, and safety management for the improvement of outcomes for patients with delirium. Through research trend analysis, we found that research on care for patients with delirium has achieved both quantitative and qualitative improvements over the last decades. Concerning future research, we propose the expansion of patient- and family-centered care, community care, specific nursing interventions, and the integration of new technology into care for patients with delirium. These results provide a reference framework for understanding and developing nursing care for older adults with delirium.

(7) Impact of a Targeted Educational Program for Delirium Screening & Prevention in Critically Ill Children

Purpose Delirium is a complex process characterized by an acute onset and fluctuating course of reduced awareness, impairments in attention, and changes in cognition. Historically delirium rates in pediatrics were ascertained solely by psychiatry consults. Improved awareness and validated screening tools for use in the PICU have provided a framework for investigating delirium in critically ill children. Delirium screening was not implemented in our PICU until adoption of the Pediatric Confusion Assessment Method for the ICU (pCAM-ICU) in July 2015 with the introduction of an online educational module. The …

Efficacy of Liaison Education and Environmental Changes on Delirium Incidence in ICU

Background: Delirium is a disorder with disturbance of consciousness, cognitive process. The present study’s aim is to evaluate the efficacy of liaison educational and environmental changes on the delirium rate in ICU patients. Methods: This is a quasi-experimental study on 148 admitted patients (over 18 years of age) in the general ICU. A total of 69 patients in the group before implementing multidisciplinary interventions and 79 patients in the group after multidisciplinary interventions were evaluated. In the case and control group RASS level of consciousness were measured. Scale ICU- CAM (at morning and evening) is used to check the incidence of delirium in the ICU patient. In addition, the demographic questionnaire has been used and delirium duration and the length of hospitalization are also evaluated in both groups. Multifactorial interventions are included as staff physicians and nurses training through a workshop. It should be noted that a 3-hour workshop is used for training of all staff personnel in the ICU ward. The 2nd part is creating environmental intervention in the ICU to decrease delirium in admitted patients. Results: In this study, 148 patients were studied, 69 patients in the group before implementing multidisciplinary interventions and 79 patients in the group after multidisciplinary interventions were evaluated. Incidence of delirium was 30 (37.97) in intervention and in 50 (72.46) control group (P = 0.01). The mean percent day in ICU patients with delirium was 26.18 ± 35.38 at intervention group and 35.84 ± 39.31 in the control group (P = 0.001). Conclusions: We found that delirium can be reduced by some intervention, and also medical team orientation about delirium can be help to reduced the incidence; therefore, it is recommended that this factor be evaluated in future study.

Familial Syndromes Involving Meningiomas Provide Mechanistic Insight Into Sporadic Disease

Currently, there is an incomplete understanding of the molecular pathogenesis of meningiomas, the most common primary brain tumor. Several familial syndromes are characterized by increased meningioma risk, and the genetics of these syndromes provides mechanistic insight into sporadic disease. The best defined of these syndromes is neurofibromatosis type 2, which is caused by a mutation in the NF2 gene and has a meningioma incidence of approximately 50%. This finding led to the subsequent discovery that NF2 loss-of-function occurs in up to 60% of sporadic tumors. Other important familial diseases with increased meningioma risk include nevoid basal cell carcinoma syndrome, multiple endocrine neoplasia 1 (MEN1), Cowden syndrome, Werner syndrome, BAP1 tumor predisposition syndrome, Rubinstein-Taybi syndrome, and familial meningiomatosis caused by germline mutations in the SMARCB1 and SMARCE1 genes. For each of these syndromes, the diagnostic criteria, incidence in the population, and frequency of meningioma are presented to review the relevant clinical information for these conditions. The genetic mutations, molecular pathway derangements, and relationship to sporadic disease for each syndrome are described in detail to identify targets for further investigation. Familial syndromes characterized by meningiomas often affect genes and pathways that are also implicated in a subset of sporadic cases, suggesting key molecular targets for therapeutic intervention. Further studies are needed to resolve the functional relevance of specific genes whose significance in sporadic disease remains to be elucidated.

Factor Analysis of Delirium in Elderly, Using the Korean Version of Delirium Rating Scale-Revised-98.

ObjectiveThis study aimed to identify the core symptoms of delirium, particularly in elderly people associated with major risk factors, using the Korean version of the Delirium Rating Scale-Revised-98.MethodsThe study sample consisted of 200 patients (mean age: 72.7±3.9 years, male: 68.5%) who had been diagnosed with delirium. Exploratory factor analysis was used to investigate the factor structure, and confirmatory factor analysis was used to evaluate the goodness of fit of the results.ResultsThe results demonstrated three core domains of delirium in the elderly patients: 1) the cognitive domain (e.g., language, thought process, orientation, attention, long-term memory, and visuospatial ability); 2) the circadian domain (e.g., sleep-wake cycle and motor behavior); and 3) the short-term memory domain (short-term memory). These results were confirmed by confirmatory factor analysis.ConclusionThe findings of this study suggest a theoretical domain structure for delirium in elderly patients.

Conscious Sedation Versus General Anesthesia in Transcatheter Aortic Valve Replacement: The German Aortic Valve Registry

ObjectivesThe aims of this study were to report on the use of local anesthesia or conscious sedation (LACS) and general anesthesia in transcatheter aortic valve replacement and to analyze the impact on outcome. BackgroundTranscatheter aortic valve replacement can be performed in LACS or general anesthesia. Potential benefits of LACS, such as faster procedures and shorter hospital stays, need to be balanced with safety. MethodsA total of 16,543 patients from the German Aortic Valve Registry from 2011 to 2014 were analyzed, and propensity-matched analyses were performed to correct for potential selection bias. ResultsLACS was used in 49% of patients (8,121 of 16,543). In hospital, LACS was associated with lower rates of low-output syndrome, respiratory failure, delirium, cardiopulmonary resuscitation, and death. There was no difference in paravalvular leakage (II+) between LACS and general anesthesia in the entire population (5% vs. 4.8%; p = 0.76) or in the matched population (3.9% vs. 4.9%, p = 0.13). The risk for prolonged intensive care unit stay (≥3 days) was significantly reduced with LACS (odds ratio: 0.82; 95% confidence interval [CI]: 0.73 to 0.92; p = 0.001). Thirty-day mortality was lower with LACS in the entire population (3.5% vs. 4.9%; hazard ratio [HR]: 0.72; 95% CI: 0.60 to 0.86; p < 0.001) and in the matched population (2.8% vs. 4.6%; HR: 0.6; 95% CI: 0.45 to 0.8; p < 0.001). However, no differences in 1-year mortality between both groups in the entire population (16.5% vs. 16.9%; HR: 0.93; 95% CI: 0.85 to 1.02; p = 0.140) and in the propensity-matched population (14.1% vs. 15.5%; HR: 0.90; 95% CI: 0.78 to 1.03; p = 0.130) were observed. ConclusionsUse of LACS in transcatheter aortic valve replacement is safe, with fewer post-procedural complications and lower early mortality, suggesting its broad application.

Poster Number: EI 35 - Prevalence and Clinical Correlates of Delirium upon Transition From Acute to Post Acute Care among Patients on Mechanical Ventilation

Introduction: The estimated prevalence of delirium at hospital admission ranges from 10–40%, whereas the incident rate of delirium during hospitalization occurs in 25–56% of patients. 3 McAvay G. Van Ness P. Bogardus S. et al. Older adults discharged from the Hospital with Delriium: 1-year outcome. J Am Geriatr Soc. 2006; 54: 1245-1250 Crossref PubMed Scopus (167) Google Scholar Studies have demonstrated that delirium may persist for weeks to months, which suggests that patients may be discharged to post-acute care settings while still delirious. 2 Simon S. Bergmann M. Jones R. et al. Reliabiity of a structured assessment for nonclinicans to detect delirium among new adissions to postacute care. J Am Med Dir Assoc. 2006; 7: 412-415 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar It is thought that the under-recognition of delirium, as well as recent declines in the length of hospital stays, have most likely contributed to patients being discharged while still experiencing delirium. 3 McAvay G. Van Ness P. Bogardus S. et al. Older adults discharged from the Hospital with Delriium: 1-year outcome. J Am Geriatr Soc. 2006; 54: 1245-1250 Crossref PubMed Scopus (167) Google Scholar

Delirium in Intensive Care Unit: Phenomenology, Subtypes, and Factor Structure of Symptoms.

Aim:This study aimed to explore the phenomenology, motor subtypes, and factor structure of symptom profile of delirium in patients admitted to the intensive care unit (ICU).Methods:Consecutive patients aged ≥16 years admitted in an ICU were screened daily for delirium using confusion assessment method-ICU. Patients diagnosed to have delirium as per Diagnostic and Statistical Manual fourth revision, text revision (DSM-IVTR) criteria were assessed with Delirium Rating Scale-Revised 98 (DRS-R 98) and Memorial Delirium Assessment Scale (MDAS). Motor subtypes of delirium were assessed with amended Delirium Motor Symptom Scale.Results:Sixty-six patients were evaluated for delirium, of which 45 (68%) patients developed delirium at point of their ICU stay. All patients had sleep-wake cycle disturbances, followed by motor symptoms (retardation - 80%; agitation - 73.3%). As per MDAS assessment, all the subjects had disturbances in the consciousness and sleep-wake cycle disturbances, and a substantial majority also had attention difficulties (93.3%) and motor symptoms (93.3%). Hypoactive subtype (47%) was the most common motoric subtype of delirium. Factor analysis revealed three-factor model for DRS-R 98, MDAS, and combining items of the two.Conclusion:Phenomenology of delirium in ICU setting is similar to that of the non-ICU settings. The factor analysis consistently demonstrated a three factor solution, with a robust attention-arousal factor, and overlapping cognitive (core vs. non-core) motor factors.

Post-operative delirium: a review of diagnosis and treatment strategies

Delirium, a syndrome characterized by disturbances in consciousness and attention, is a serious post-operative complication. Medical professionals have been trying to manage delirium for the past 2,000 years, and yet the pathophysiology and the best treatment remain unclear. Failure to diagnose and adequately treat delirium creates harmful situations for patients. Delirium has been shown to be associated with longer lengths of stay, facility discharges, and increased mortality. The following review highlights what is currently known about post-operative delirium (POD) and ways to best manage it. This review will explore risk factors in both cardiac and noncardiac surgery, discuss risk stratification models, examine commonly used tools to diagnose delirium, and evaluate current evidence as it relates to possible ways to treat delirium. For patients experiencing POD, geriatric consultation and multi-component interventions have both been shown to reduce the incidence of delirium. Current literature does not support the use of antipsychotics, benzodiazepines, cholinesterase inhibitors, or melatonin in the management of POD. Finally, intraoperative dexmedetomidine has not been associated with lower rates of delirium, but its use postoperatively in the ICU has been linked to less delirium when compared to propofol. At this time, non-pharmacological measures remain the hallmark of treatment. Continued research in the best strategies for delirium management is needed.

Pattern of perioperative gabapentinoid use and risk for postoperative naloxone administration

BackgroundSingle preoperative gabapentinoid (gabapentin and pregabalin) administration has been associated with respiratory depression during Phase I anaesthesia recovery. In this study, we assess for associations between chronic (home) use and perioperative administration (preoperative and postoperative) of gabapentinoids, and risk for severe over-sedation or respiratory depression as inferred from the use of naloxone. MethodsFrom 2011 to 2016, we identified patients undergoing general anaesthesia discharged to standard postoperative wards and administered naloxone within 48 h of surgery in a single centre. These patients were 2:1 matched on age, sex, and type of procedure. Patient and perioperative characteristics were abstracted and compared to assess for risk for naloxone administration. ResultsWe identified 128 patients that received naloxone after operation [odds ratio 1.2; 95% confidence interval (CI) 1.0, 1.4 per 1000 general anaesthetics]. Patients on chronic or postoperative gabapentinoid therapy were at significantly higher risk for receiving naloxone after operation. Multivariable analysis detected significant interactions between chronic and postoperative use of gabapentinoids, where continuation of chronic gabapentinoid medications into the postoperative period was associated with an increased rate of naloxone administration (6.30, 95% CI 2.4, 16.7; P=0.001). Obstructive sleep apnoea (P=0.005) and preoperative disability (P=0.003) were also associated with an increased risk for postoperative naloxone administration. Patients who received naloxone had longer hospital stays and higher rates of postoperative delirium. ConclusionsContinuation of chronic gabapentinoid medications into the postoperative period is associated with the increased use of naloxone to reverse over-sedation or respiratory depression. Such patients requiring this therapy warrant high levels of postoperative monitoring.

Delirium during the first evaluation of children aged five to 14 years admitted to a paediatric critical care unit

ObjectivesTo describe the prevalence and characteristics of delirium during the initial evaluation of critically ill patients aged 5–14 years. Method/designThis is a cross-sectional descriptive study in a critical care unit. For six months, all patients were evaluated within the first 24–72 hours or when sedation permitted the use of the paediatric confusion assessment method for the intensive care unit (PCAM-ICU) and the Delirium Rating Scale-Revised-98 items #7 and #8 to determine motor type. We report the characteristics of PCAM-ICU delirium (at least three of the required items scored positive) and of subthreshold score cases (two positive items). ResultsOf 77 admissions, 15 (19.5%) had delirium, and 11 (14.2%) were subthreshold. A total of 53.3% of delirium and 45.5% of subthreshold cases were hypoactive. The prevalence of delirium and subthreshold PCAM-ICU was 83.3% and 16.7% in mechanically ventilated children. The most frequent combination of PCAM-ICU alterations in subthreshold cases was acute onset-fluctuation with altered alertness. The main nursing diagnoses were related to reduced cellular respiration. ConclusionsDelirium is common in critically ill children. It is necessary to assess whether certain nursing diagnoses imply an increase in delirium. Longitudinal studies of subthreshold PCAM-ICU cases are needed to understand their importance better.

Detecting Delirium in Hospitalized Elderly Patients: A Review of Practice Compliance.

Background: The Ontario Senior Friendly Hospital Strategy recognizes delirium prevention and management as a top priority and recommends implementation of delirium screening as well as management protocols. This strategy proposes that hospitals monitor 2 specific indicators: (1) rate of baseline delirium screening and (2) rate of hospital-acquired delirium. Objective: To (1) determine compliance with the Ontario Senior Friendly Hospital Strategy indicators; (2) describe the use of pharmacological and nonpharmacological interventions for management of delirious patients; and (3) identify predictors of screening compliance. Methods: We conducted a retrospective review of patients aged ≥65 years admitted to 4 different inpatient units for ≥48 hours. Data were extracted for 7 two-month time blocks chosen between September 2010 and October 2013, following the implementation of various geriatric and delirium related initiatives at the hospital. Results: A total of 786 patients met study inclusion criteria. Overall, 68.2% had baseline delirium screening (indicator 1), with screening rates increasing over time (P < .001). Inpatient unit and year of study were both statistically significant predictors of delirium screening. Among those screened, the overall rate of hospital-acquired delirium was 17.2% (indicator 2). Early mobilization and device removal were the most common nonpharmacological interventions, while initiation of an antipsychotic and discontinuation of benzodiazepines were the most common pharmacological interventions. Conclusions: Although the rates of baseline delirium screening have significantly increased over the sampled time period, rates are still below the averages referenced in other literature. Our study suggests we need additional efforts to improve compliance with delirium screening in our institution.

Comprehensive geriatric assessment for older people admitted to a surgical service.

Aging populations are at increased risk of postoperative complications. New methods to provide care for older people recovering from surgery may reduce surgery-related complications. Comprehensive geriatric assessment (CGA) has been shown to improve some outcomes for medical patients, such as enabling them to continue living at home, and has been proposed to have positive impacts for surgical patients. CGA is a coordinated, multidisciplinary collaboration that assesses the medical, psychosocial and functional capabilities and limitations of an older person, with the goal of establishing a treatment plan and long-term follow-up. To assess the effectiveness of CGA interventions compared to standard care on the postoperative outcomes of older people admitted to hospital for surgical care. We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two clinical trials registers on 13 January 2017. We also searched grey literature for additional citations. Randomized trials of people undergoing surgery aged 65 years and over comparing CGA with usual surgical care and reporting any of our primary (mortality and discharge to an increased level of care) or secondary (length of stay, re-admission, total cost and postoperative complication) outcomes. We excluded studies if the participants did not receive a complete CGA, did not undergo surgery, and if the study recruited participants aged less than 65 years or from a setting other than an acute care hospital. Two review authors independently screened, assessed risk of bias, extracted data and assessed certainty of evidence from identified articles. We expressed dichotomous treatment effects as risk ratio (RR) with 95% confidence intervals and continuous outcomes as mean difference (MD). We included eight randomised trials, seven recruited people recovering from a hip fracture (N = 1583) and one elective surgical oncology trial (N = 260), conducted in North America and Europe. For two trials CGA was done pre-operatively and postoperatively for the remaining. Six trials had adequate randomization, five had low risk of performance bias and four had low risk of detection bias. Blinding of participants was not possible. All eight trials had low attrition rates and seven reported all expected outcomes.CGA probably reduces mortality in older people with hip fracture (RR 0.85, 95% CI 0.68 to 1.05; 5 trials, 1316 participants, I² = 0%; moderate-certainty evidence). The intervention reduces discharge to an increased level of care (RR 0.71, 95% CI 0.55 to 0.92; 5 trials, 941 participants, I² = 0%; high-certainty evidence).Length of stay was highly heterogeneous, with mean difference between participants allocated to the intervention and the control groups ranging between -12.8 and 8.3 days. CGA probably leads to slightly reduced length of stay (4 trials, 841 participants, moderate-certainty evidence). The intervention probably makes little or no difference in re-admission rates (RR 1.00, 95% CI 0.76 to 1.32; 3 trials, 741 participants, I² = 37%; moderate-certainty evidence).CGA probably slightly reduces total cost (1 trial, 397 participants, moderate-certainty evidence). The intervention may make little or no difference for major postoperative complications (2 trials, 579 participants, low-certainty evidence) and delirium rates (RR 0.75, 95% CI 0.60 to 0.94, 3 trials, 705 participants, I² = 0%; low-certainty evidence). There is evidence that CGA can improve outcomes in people with hip fracture. There are not enough studies to determine when CGA is most effective in relation to surgical intervention or if CGA is effective in surgical patients presenting with conditions other than hip fracture.