Unraveling the impact of frailty on postoperative delirium in elderly surgical patients: a systematic review and meta-analysis.

IF 2.3 3区医学 Q2 ANESTHESIOLOGY

BMC Anesthesiology Pub Date : 2025-03-06 DOI:10.1186/s12871-025-02994-3

Haotian Wu, Siyi Yan, Han Cao, Chunyu Feng, Huan Zhang

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Abstract

Background: Frailty has been consistently implicated as a pivotal factor in the onset of delirium following anesthesia and surgery. Nonetheless, a comprehensive understanding of the relationship between frailty and delirium remains to be elucidated. This study addresses that knowledge gap.

Methods: A comprehensive search of literature databases identified 43 relevant studies involving 14,441 participants. The studies were subjected to a rigorous quality assessment using the Newcastle-Ottawa Scale. Statistical analysis was conducted using Review Manager (v5.4.1), including subgroup and sensitivity analyses.

Results: Meta-analysis revealed a significant association between preoperative physical frailty and postoperative delirium (pooled odds ratio: 2.47; 95% confidence interval: 2.04-2.99; I² = 46.7%). The baseline frailty rate was 34.0% (4,910/14,441), while the overall incidence of postoperative delirium was 20% (2,783/14,441). Subgroup analyses based on characteristics such as race, frailty-assessment tools, and surgical types were conducted to explore potential sources of heterogeneity. This meta-analysis provided compelling evidence supporting a notable link between preoperative physical frailty and an increased risk of postoperative delirium in older surgical patients. Early identification through frailty screening can enable targeted interventions, potentially enhancing overall management and individualized treatment. Integrating frailty assessment into preoperative evaluation may improve predictive accuracy in surgical planning and anesthesia management.

Conclusions: Future research could focus on optimizing the integration of frailty assessment into preoperative protocols for timely intervention and improved patient outcomes.

Trial registration: The review protocol was registered with PROSPERO (CRD42023390486), date of registration: Aug 11, 2023.

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揭示衰弱对老年外科患者术后谵妄的影响：一项系统回顾和荟萃分析。

背景：虚弱一直被认为是麻醉和手术后谵妄发作的关键因素。尽管如此，对虚弱和谵妄之间关系的全面理解仍有待阐明。这项研究解决了这一知识差距。方法：综合检索文献数据库，确定43项相关研究，涉及14441名受试者。这些研究采用纽卡斯尔-渥太华量表进行了严格的质量评估。使用Review Manager （v5.4.1）进行统计分析，包括亚组分析和敏感性分析。结果：荟萃分析显示术前身体虚弱和术后谵妄之间存在显著关联(合并优势比：2.47；95%置信区间：2.04-2.99；i2 = 46.7%)。基线虚弱率为34.0%(4,910/14,441)，而术后谵妄的总发生率为20%（2,783/14,441）。基于种族、衰弱评估工具和手术类型等特征进行亚组分析，以探索异质性的潜在来源。这项荟萃分析提供了令人信服的证据，支持术前身体虚弱和老年手术患者术后谵妄风险增加之间的显著联系。通过虚弱筛查进行早期识别可以实现有针对性的干预，从而有可能加强整体管理和个性化治疗。将衰弱评估纳入术前评估可以提高手术计划和麻醉管理的预测准确性。结论：未来的研究应侧重于优化将衰弱评估纳入术前方案，以及时干预并改善患者预后。试验注册：审查方案在PROSPERO注册（CRD42023390486），注册日期：2023年8月11日。

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

BMC Anesthesiology ANESTHESIOLOGY-

CiteScore

3.50

自引率

4.50%

发文量

349

审稿时长

>12 weeks

期刊介绍： BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.