Patients with past depression or depressive-symptoms preoperatively have significantly greater risk of post-operative delirium (RR 1.91, 95% CI 1.68-2.17).

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• Calvin Diep, Krisha Patel, Jessica Petricca, Julian F Daza, Sandra Lee, Yuanxin Xue, Luka Kremic, Maggie Z X Xiao, Bianca Pivetta, Simone N Vigod, Duminda N Wijeysundera, and Karim S Ladha.
• Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
• Anaesthesia. 2024 Nov 1; 79 (11): 123712491237-1249.

BackgroundDelirium is a common and potentially serious complication after major surgery. A previous history of depression is a known risk factor for experiencing delirium in patients admitted to the hospital, but the generalised risk has not been estimated in surgical patients.MethodsWe conducted a systematic review and meta-analysis of studies reporting the incidence or relative risk (or relative odds) of delirium in the immediate postoperative period for adults with pre-operative depression. We included studies that defined depression as either a formal pre-existing diagnosis or having clinically important depressive symptoms measured using a patient-reported instrument before surgery. Multilevel random effects meta-analyses were used to estimate the pooled incidences and pooled relative risks. We also conducted subgroup analyses by various study-level characteristics to identify important moderators of pooled estimates.ResultsForty-two studies (n = 4,664,051) from five continents were included. The pooled incidence of postoperative delirium for patients with pre-operative depression was 29% (95%CI 17-43%, I2 = 99.0%), compared with 15% (95%CI 6-28%, I2 = 99.8%) in patients without pre-operative depression and 21% (95% CI 11-33%, I2 = 99.8%) in the cohorts overall. For patients with pre-operative depression, the risk of delirium was 1.91 times greater (95%CI 1.68-2.17, I2 = 42.0%) compared with patients without pre-operative depression.ConclusionsPatients with a previous diagnosis of depression or clinically important depressive symptoms before surgery have substantially greater risk of experiencing delirium after surgery. Clinicians and patients should be informed of these increased risks. Robust screening and other risk mitigation strategies for postoperative delirium are warranted, especially for patients with pre-operative depression.© 2024 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

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