Risk factors and consequences of post-esophagectomy delirium: a systematic review and meta-analysis

医学 荟萃分析 优势比 谵妄 背景(考古学) 内科学 食管切除术 共病 置信区间 梅德林 严格标准化平均差 重症监护医学 食管癌 生物 癌症 古生物学 法学 政治学
作者
Dimitrios Papaconstantinou,Maximos Frountzas,Jelle P. Ruurda,S. Mantziari,Diamantis I. Tsilimigras,Νικόλαος Κολιάκος,Georgios Tsivgoulis,Dimitrios Schizas
出处
期刊:Diseases of The Esophagus [Oxford University Press]
卷期号:36 (8) 被引量:2
标识
DOI:10.1093/dote/doac103
摘要

Abstract Post-operative delirium (POD) is a state of mental and neurocognitive impairment characterized by disorientation and fluctuating levels of consciousness. POD in the context of esophageal surgery may herald serious and potentially life-threatening post-operative complications, or conversely be a symptom of severe underlying pathophysiologic disturbances. The aim of the present systematic review and meta-analysis is to explore risk factors associated with the development of POD and assess its impact on post-operative outcomes. A systematic literature search of the MedLine, Web of Science, Embase and Cochrane CENTRAL databases and the clinicaltrials.gov registry was undertaken. A random-effects model was used for data synthesis with pooled outcomes expressed as Odds Ratios (OR), or standardized mean differences (WMD) with corresponding 95% Confidence Intervals. Seven studies incorporating 2449 patients (556 with POD and 1893 without POD) were identified. Patients experiencing POD were older (WMD 0.29 ± 0.13 years, P < 0.001), with higher Charlson’s Comorbidity Index (CCI; WMD 0.31 ± 0.23, P = 0.007) and were significantly more likely to be smokers (OR 1.38, 95% CI 1.07–1.77, P = 0.01). Additionally, POD was associated with blood transfusions (OR 2.08, 95% CI 1.56–2.77, P < 0.001), and a significantly increased likelihood to develop anastomotic leak (OR 2.03, 95% CI 1.25–3.29, P = 0.004). Finally, POD was associated with increased mortality (OR 2.71, 95% CI 1.24–5.93, P = 0.01) and longer hospital stay (WMD 0.4 ± 0.24, P = 0.001). These findings highlight the clinical relevance and possible economic impact of POD after esophagectomy for malignant disease and emphasize the need of developing effective preventive strategies.
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