Effectiveness of drug interventions to prevent delirium after surgery for older adults: systematic review and network meta-analysis of randomised controlled trials
Abstract
Objective: To identify which drugs are effective at preventing delirium after surgery in adults over 60 years of age and estimate the effects on morbidity and mortality.
Design: Systematic review and network meta-analysis.
Data sources: Embase, Medline, and Cochrane Library up to 4 March 2024.
Eligibility criteria: Randomised controlled trials with administration of one or more drugs for the prevention of delirium after surgery requiring general or regional anaesthesia that recruited participants at least 60 years old and used a validated delirium assessment tool to measure the outcome. Surgery under local anaesthesia only, preoperative mechanical ventilation, and studies of interventions to treat delirium were excluded.
Data extraction and synthesis: Assessors masked to each other's decisions screened studies, extracted data, and assessed risk of bias and quality of evidence in duplicate by using the Cochrane risk of bias tool version 2 and the CINeMA tool. Bayesian arm based network meta-analysis was used to compare interventions.
Results: 158 trials were identified with 41 084 participants comparing 52 drug interventions. Seventeen trials were rated as being at high risk of bias. The overall risk of delirium after surgery was 14.5% (n=5957). Dexmedetomidine (odds ratio 0.46, 95% credible interval 0.36 to 0.57), corticosteroids (0.53, 0.31 to 0.87), melatonin receptor agonists (0.54, 0.34 to 0.85), parecoxib (0.34, 0.16 to 0.74), olanzapine (0.27, 0.07 to 0.94), and…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 5,957 participants or records.
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