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Preventive interventions, including pharmacologic, anesthesia, and bundle-care interventions, can reduce the rate of postoperative delirium among patients.

Preventive interventions nearly halved the risk of postoperative delirium (POD) among patients recovering from intraabdominal surgery, according to a systematic review and meta-analysis published online in The American Journal of Surgery.

“The results highlight that various preventive interventions, rather than a single principle intervention, can effectively reduce the incidence of POD in surgical patients,” researchers wrote. “Moderate statistical heterogeneity was noted (I² ​= ​60​%) and publication bias was present collectively leading to a low certainty of evidence for this outcome.”

Experts expect the incidence of POD to increase as the population ages. Consequently, strategies to prevent POD are critical, according to the authors.

The study included 16 randomized controlled trials of strategies used to prevent POD in adults undergoing intraabdominal surgery. Preventive strategies included pharmacologic interventions (intranasal insulin, glucocorticoids, and dexmedetomidine) in seven trials; anesthesia interventions (epidural anesthesia, spinal block, mean arterial pressure target, fraction of inspired oxygen index, and sevoflurane-based anesthesia) in seven trials; and bundle-care interventions (fast-track surgery and a family support program) in two trials.

Surgical Approach Impacts POD Risk

Among a total 4,060 participants included in the analysis, 527 delirium events were reported. The incidence of POD ranged from 3.4% to 34.6​% in intervention groups and from 4.6% to 47.5​% in control groups.

Collectively, preventive interventions reduced the risk of postoperative delirium by 49%, according to the study. In contrast, preventive interventions showed no significant effects for the secondary outcomes of 30-day mortality, 180-day mortality, and postoperative complications.

“The lack of significant findings in these areas can be attributed to the limited number of studies reporting these outcomes and events, which can be explained by low event rate and being secondary outcomes of included trials,” researchers wrote.

However, interventions also had no significant effect on hospital length of stay, which was reported on in 13 studies. Previous studies have suggested a potential benefit.

In subgroup analyses of mixed, open, and laparoscopic surgical approaches, preventive interventions showed the largest effect in laparoscopic surgeries. Researchers reported a 49% reduced risk of POD in intervention groups compared with control groups across eight studies.

“This suggests that minimally invasive surgical techniques might play a crucial role in reducing POD risk,” they wrote. “While data on robotic-assisted surgery are limited, it is hypothesized that robotic techniques might offer similar benefits due to their minimally invasive nature and precise surgical control.”