• Huawei Huang, Haoyi Li, Xiaokang Zhang, Guangzhi Shi, Ming Xu, Xiaojuan Ru, You Chen, Mayur B Patel, Eugene Wesley Ely, Song Lin, Guobin Zhang, and Jianxin Zhou.
• Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
• J Clin Anesth. 2021 Dec 1; 75: 110496.

Study ObjectiveTo determine the association between postoperative delirium (POD) and cognitive outcomes at least 1 month after surgery in elderly patients, and synthesize the dynamic risk trajectory of cognition impairment after POD.DesignMeta-analysis searching PubMed, Cochrane and EMBASE from inception to November 1, 2020. The terms postoperative delirium, delirium after surgery, postsurgical delirium, postoperative cogniti*, postoperative cognitive dysfunction, postoperative cognition decline, cognitive decline, cognitive impair* and dement* were searched alone or in combination.MeasurementsInclusion criteria were prospective cohort studies investigating the association between POD and cognitive outcomes in patients aged ≥60 years underwent surgery. The primary outcome was the association between POD and cognitive outcomes at 1 or more months after surgery. We considered cognitive outcomes measured up to 12 months after surgery as short-term and beyond 12 months as long-term. Two authors performed the study screening, data extraction and quality assessments. Effect sizes were calculated as Hedges g or Odds ratio (OR) based on random- and fixed-effects models. Meta-regression was conducted to analyze the role of potential contributors to heterogeneity.Main ResultsEighteen studies were included. Our result showed a significant and medium association between POD and cognitive outcomes after at least 1 month postoperatively (g = 0.61 95% CI 0.43-0.79; I2 = 65.1%), indicating that patients with POD were associated with worse cognitive outcomes. The association of POD with short- and long-term cognitive impairment were also both significant (short-term: g = 0.46 95% CI 0.24-0.68; I2 = 53.1%; and long-term: g = 0.82 95% CI 0.57-1.06; I2 = 57.1%). A multivariate meta-regression suggested that age and measure of delirium were significant sources of heterogeneity. POD was also associated with the significant risk for dementia (OR = 6.08 95% CI 3.80-9.72; I2 = 0) as well as attention (OR = 1.74 95% CI 1.13-2.68; I2 = 0), executive (OR = 1.33 95% CI 1.00-1.80; I2 = 0) and memory impairment (OR = 1.59 95% CI 1.20-2.10; I2 = 43.0%). Additionally, our results showed that the risk trajectory for cognitive decline associated with POD within five years after surgery revealed exponential growth.ConclusionsThis is the first meta-analysis quantifying the association between POD and cognitive outcomes. Our results showed that POD was significantly associated with worse cognitive outcomes, including short- and long-term cognitive outcomes following surgery.Copyright © 2021. Published by Elsevier Inc.

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