Delirium in neurosurgery: a systematic review and meta-analysis

Area of Science:

• Neurosurgery
• Critical Care Medicine
• Geriatric Medicine

Background:

• Delirium is a common complication in surgical patients.
• The clinical relevance of delirium after intracranial surgery is not well-established.
• A comprehensive understanding of delirium's impact in this specific population is lacking.

Purpose of the Study:

• To systematically review the diagnostic work-up, incidence, risk factors, and health outcomes of delirium in patients following intracranial surgery.
• To synthesize current evidence on delirium assessment and its consequences in neurosurgical patients.

Main Methods:

• Systematic review of five databases (Embase, Medline, Web of Science, PsycINFO, Cochrane Central) from inception to March 31st, 2021.
• Inclusion of 24 studies (5589 patients) for qualitative analysis and 21 studies (5083 patients) for quantitative analysis.
• Analysis of validated delirium screening tools used across studies, including the Confusion Assessment Method (intensive care unit) and others.

Main Results:

• The overall incidence of post-operative delirium after intracranial surgery was 19%, with a range of 12-26%.
• Validated delirium screening tools were employed in 70% of the reviewed studies.
• Meta-regression analysis indicated no correlation between delirium incidence and age or gender.

Conclusions:

• Delirium is a significant complication in post-intracranial surgery patients, with an incidence of 19%.
• Current diagnostic methods and assessment tools show variability.
• Future research should prioritize optimizing delirium diagnosis, evaluating its prognostic significance, and developing effective management strategies in neurosurgery.