Do antipsychotics prevent postoperative delirium? A systematic review and meta-analysis

Area of Science:

• Geriatric Medicine
• Anesthesiology
• Psychiatry

Background:

• Postoperative delirium is a common complication in surgical patients.
• Antipsychotics are a class of drugs used to manage psychosis and other mental health conditions.

Purpose of the Study:

• To evaluate the efficacy of antipsychotics in preventing postoperative delirium.
• To identify factors influencing the effectiveness of antipsychotics for delirium prevention.

Main Methods:

• Systematic literature search of multiple databases and clinical trials registries.
• Inclusion of randomized controlled trials (RCTs) in adult surgical patients.
• Random-effects meta-analysis and meta-regression to assess treatment effects and heterogeneity.

Main Results:

• Antipsychotics significantly reduced the incidence of postoperative delirium (weighted odds ratio: 0.44).
• Significant heterogeneity was observed, with baseline delirium risk, antipsychotic type, and dosage identified as contributing factors.
• A potential breakeven point for baseline delirium risk was suggested, below which antipsychotics may be less effective.

Conclusions:

• Antipsychotics show promise in reducing postoperative delirium incidence across various surgical settings.
• Effectiveness appears more pronounced in orthopedic surgery and in patients with a higher risk of delirium.
• Further research is needed due to the limited number of high-quality RCTs.