Pharmacologic prophylaxis of postoperative delirium in elderly patients: A network meta-analysis of randomized controlled trials

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research Pub Date : 2024-11-12 DOI:10.1016/j.jpsychires.2024.11.002

Ting-Hui Liu , Yen-Ting Lin , Jheng-Yan Wu , Po-Yu Huang , Wen-Wen Tsai , Chih-Cheng Lai , Pei-Hsin Kao , Kuan-Pin Su

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引用次数: 0

Abstract

Background

The high incidence and mortality rates of postoperative delirium (POD) among elderly patients highlights the pressing need for tailored prophylactic strategies. Despite various pharmacologic prophylactic strategies have been reported effective, their overall benefit and safety remain unclear in the geriatric population. Our network meta-analysis (NMA) aimed to systematically evaluate and rank the effectiveness of various pharmacological interventions in preventing POD in elderly patients.

Methods

We conducted an extensive search of PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and Google Scholar for randomized controlled trials (RCTs) published up to August 1, 2023. We included RCTs examining pharmacological prophylactic effects of POD in elderly patients. To extract data in alignment with predefined areas of interest, we employed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The primary outcome was the incidence of POD. For secondary outcomes, we evaluated tolerability through all-cause discontinuation or drop-out rates, as well as all-cause mortality.

Results

Our analysis encompassed a total of 44 RCTs involving 11,178 patients. Out of these, 26 RCTs involved comparisons with placebo only. For delirium prevention, the treatment groups receiving atypical antipsychotics (odds ratio (OR) of 0.27 and 95% confidence interval (CI) of 0.12–0.58), haloperidol (OR of 0.42; 95% CI of 0.25–0.71), dexmedetomidine (OR of 0.51 and 95% CI of 0.37–0.71 and melatonergic agents (MMA) (OR of 0.57 and 95% CI of 0.33–0.98) had significantly lower rates of delirium compared to the placebo group. Notably, the atypical antipsychotics ranked as the most effective treatment. For tolerability, no statistically differences in rates of dropout discontinuation and all-cause mortality among groups allocated to the placebo or individual pharmacological treatments.

Conclusions

Based on indirect evidence, our network meta-analysis identified atypical antipsychotics, dexmedetomidine, MMA, and haloperidol as effective in preventing POD in the elderly, with atypical antipsychotics ranking highest. However, it is essential to note that these findings should be confirmed through further RCTs.

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老年患者术后谵妄的药物预防：随机对照试验的网络荟萃分析

背景老年患者术后谵妄（POD）的高发病率和死亡率凸显了针对性预防策略的迫切需要。尽管各种药物预防策略已被报道有效，但它们在老年人群中的总体效益和安全性仍不清楚。我们的网络荟萃分析（NMA）旨在系统评估和排名各种药物干预措施在预防老年患者POD中的有效性。方法我们对PubMed、Embase、Cochrane Central Register of Controlled Trials、PsycINFO和谷歌Scholar进行了广泛的检索，检索截至2023年8月1日发表的随机对照试验（rct）。我们纳入了检查POD对老年患者的药理学预防作用的随机对照试验。为了提取与预先定义的兴趣领域一致的数据，我们采用了系统评价和元分析指南的首选报告项目。主要观察指标为POD的发生率。对于次要结局，我们通过全因停药或退出率以及全因死亡率来评估耐受性。结果我们的分析共纳入44项随机对照试验，涉及11,178例患者。其中，26项随机对照试验只涉及安慰剂的比较。对于谵妄的预防，治疗组使用非典型抗精神病药物（优势比（OR）为0.27,95%可信区间（CI）为0.12-0.58）、氟哌啶醇(OR为0.42；95% CI为0.25-0.71)，右美托咪定（OR为0.51,95% CI为0.37-0.71）和褪黑激素（MMA）（OR为0.57,95% CI为0.33-0.98）与安慰剂组相比，谵妄的发生率显著降低。值得注意的是，非典型抗精神病药物是最有效的治疗方法。在耐受性方面，在分配给安慰剂组或单独药物治疗组的中途停药率和全因死亡率方面没有统计学差异。结论基于间接证据，我们的网络meta分析确定非典型抗精神病药物、右美托咪定、MMA和氟哌啶醇对老年人POD的预防有效，其中非典型抗精神病药物排名最高。然而，必须注意的是，这些发现应该通过进一步的随机对照试验来证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of psychiatric research 医学-精神病学

CiteScore

7.30

自引率

2.10%

发文量

622

审稿时长

130 days

期刊介绍： Founded in 1961 to report on the latest work in psychiatry and cognate disciplines, the Journal of Psychiatric Research is dedicated to innovative and timely studies of four important areas of research: (1) clinical studies of all disciplines relating to psychiatric illness, as well as normal human behaviour, including biochemical, physiological, genetic, environmental, social, psychological and epidemiological factors; (2) basic studies pertaining to psychiatry in such fields as neuropsychopharmacology, neuroendocrinology, electrophysiology, genetics, experimental psychology and epidemiology; (3) the growing application of clinical laboratory techniques in psychiatry, including imagery and spectroscopy of the brain, molecular biology and computer sciences;