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Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis

BACKGROUND: Postoperative delirium (POD) is a common postoperative complication associated with multiple adverse consequences on patient outcomes and higher medical expenses. Preoperative anxiety has been suggested as a possible precipitating factor for the development of POD. As such, we aimed to e...

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Autores principales: Yang, Ke-Lu, Detroyer, Elke, Van Grootven, Bastiaan, Tuand, Krizia, Zhao, Dan-Ni, Rex, Steffen, Milisen, Koen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064748/
https://www.ncbi.nlm.nih.gov/pubmed/36997928
http://dx.doi.org/10.1186/s12877-023-03923-0
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author Yang, Ke-Lu
Detroyer, Elke
Van Grootven, Bastiaan
Tuand, Krizia
Zhao, Dan-Ni
Rex, Steffen
Milisen, Koen
author_facet Yang, Ke-Lu
Detroyer, Elke
Van Grootven, Bastiaan
Tuand, Krizia
Zhao, Dan-Ni
Rex, Steffen
Milisen, Koen
author_sort Yang, Ke-Lu
collection PubMed
description BACKGROUND: Postoperative delirium (POD) is a common postoperative complication associated with multiple adverse consequences on patient outcomes and higher medical expenses. Preoperative anxiety has been suggested as a possible precipitating factor for the development of POD. As such, we aimed to explore the association between preoperative anxiety and POD in older surgical patients. METHODS: Electronic databases including MEDLINE (via PubMed), EMBASE (via Embase.com), Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL Complete; via EBSCOhost) and clinical trial registries were systematically searched to identify prospective studies examining preoperative anxiety as a risk factor for POD in older surgical patients. We used Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies to assess the quality of included studies. The association between preoperative anxiety and POD was summarized with odds ratios (ORs) and 95% confidence intervals (CIs) using DerSimonian-Laird random-effects meta-analysis. RESULTS: Eleven studies were included (1691 participants; mean age ranging between 63.1–82.3 years). Five studies used a theoretical definition for preoperative anxiety, with the Anxiety subscale of Hospital Anxiety and Depression Scale (HADS-A) as the instrument being most often used. When using dichotomized measures and within the HADS-A subgroup analysis, preoperative anxiety was significantly associated with POD (OR = 2.17, 95%CI: 1.01–4.68, I(2) = 54%, Tau(2) = 0.4, n = 5; OR = 3.23, 95%CI: 1.70–6.13, I(2) = 0, Tau(2) = 0, n = 4; respectively). No association was observed when using continuous measurements (OR = 0.99, 95%CI: 0.93–1.05, I(2) = 0, Tau(2) = 0, n = 4), nor in the subgroup analysis of STAI-6 (six-item version of state scale of Spielberger State-Trait Anxiety Inventory, OR = 1.07, 95%CI: 0.93–1.24, I(2) = 0, Tau(2) = 0, n = 2). We found the overall quality of included studies to be moderate to good. CONCLUSIONS: An unclear association between preoperative anxiety and POD in older surgical patients was found in our study. Given the ambiguity in conceptualization and measurement instruments used for preoperative anxiety, more research is warranted in which a greater emphasis should be placed on how preoperative anxiety is operationalized and measured. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-023-03923-0.
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spelling pubmed-100647482023-04-01 Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis Yang, Ke-Lu Detroyer, Elke Van Grootven, Bastiaan Tuand, Krizia Zhao, Dan-Ni Rex, Steffen Milisen, Koen BMC Geriatr Research BACKGROUND: Postoperative delirium (POD) is a common postoperative complication associated with multiple adverse consequences on patient outcomes and higher medical expenses. Preoperative anxiety has been suggested as a possible precipitating factor for the development of POD. As such, we aimed to explore the association between preoperative anxiety and POD in older surgical patients. METHODS: Electronic databases including MEDLINE (via PubMed), EMBASE (via Embase.com), Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL Complete; via EBSCOhost) and clinical trial registries were systematically searched to identify prospective studies examining preoperative anxiety as a risk factor for POD in older surgical patients. We used Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies to assess the quality of included studies. The association between preoperative anxiety and POD was summarized with odds ratios (ORs) and 95% confidence intervals (CIs) using DerSimonian-Laird random-effects meta-analysis. RESULTS: Eleven studies were included (1691 participants; mean age ranging between 63.1–82.3 years). Five studies used a theoretical definition for preoperative anxiety, with the Anxiety subscale of Hospital Anxiety and Depression Scale (HADS-A) as the instrument being most often used. When using dichotomized measures and within the HADS-A subgroup analysis, preoperative anxiety was significantly associated with POD (OR = 2.17, 95%CI: 1.01–4.68, I(2) = 54%, Tau(2) = 0.4, n = 5; OR = 3.23, 95%CI: 1.70–6.13, I(2) = 0, Tau(2) = 0, n = 4; respectively). No association was observed when using continuous measurements (OR = 0.99, 95%CI: 0.93–1.05, I(2) = 0, Tau(2) = 0, n = 4), nor in the subgroup analysis of STAI-6 (six-item version of state scale of Spielberger State-Trait Anxiety Inventory, OR = 1.07, 95%CI: 0.93–1.24, I(2) = 0, Tau(2) = 0, n = 2). We found the overall quality of included studies to be moderate to good. CONCLUSIONS: An unclear association between preoperative anxiety and POD in older surgical patients was found in our study. Given the ambiguity in conceptualization and measurement instruments used for preoperative anxiety, more research is warranted in which a greater emphasis should be placed on how preoperative anxiety is operationalized and measured. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-023-03923-0. BioMed Central 2023-03-30 /pmc/articles/PMC10064748/ /pubmed/36997928 http://dx.doi.org/10.1186/s12877-023-03923-0 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Yang, Ke-Lu
Detroyer, Elke
Van Grootven, Bastiaan
Tuand, Krizia
Zhao, Dan-Ni
Rex, Steffen
Milisen, Koen
Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis
title Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis
title_full Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis
title_fullStr Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis
title_full_unstemmed Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis
title_short Association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis
title_sort association between preoperative anxiety and postoperative delirium in older patients: a systematic review and meta-analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064748/
https://www.ncbi.nlm.nih.gov/pubmed/36997928
http://dx.doi.org/10.1186/s12877-023-03923-0
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