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The effects of early postoperative neurocognitive disorders on clinically relevant outcomes: a meta-analysisстатья
- Авторы: Likhvantsev Valery V., Landoni Giovanni, Berikashvili Levan B., Ermokhina Nadezhda V., Yadgarov Mikhail Ya, Kotani Yuki, Kadantseva Kristina K., Makarevich Dmitry M., Grechko Andrey V.
- Журнал: Korean Journal of Anesthesiology
- Год издания: 2023
- Издательство: Korean Society of Anesthesiologists
- Местоположение издательства: Korea, Republic of
- DOI: 10.4097/kja.23126
- Аннотация: BackgroundEarly postoperative neurocognitive disorders (ePND) include emergence delirium, defined as a very early onset postoperative delirium, and emergence agitation, defined as motor arousal. These ways of anesthesia emergence are poorly investigated although they are probably associated with unfavorable outcomes. This meta-analysis aimed to assess the impact of ePND on clinically relevant outcomes.MethodsA systematic search of studies published over the past 20 years was carried out in Medline, PubMed, Google Scholar and Cochrane Library. We included studies describing adults with emergence agitation and/or emergence delirium and reporting at least one of the following: mortality, postoperative delirium, length post-anesthesia care unit or hospital stay. The internal validity, risk of bias, and certainty of evidence were assessed.ResultsA total of 16,028 patients from 21 prospective observational studies and 1 case-control retrospective study were included in this meta-analysis. The rate of ePND occurrence was 13 % (from 21 studies excluding the case-control study). The mortality rate was 2.4 % in patients with ePND vs 1.2 % in normal emergence group (RR = 2.6, p = 0.01, very low quality of evidence). Postoperative delirium was 29 % in patients with ePND vs 4.5 % in patients with normal emergence (RR = 9.5, p < 0.001, I2 = 93%). Patients with ePND had a prolonged length of post-anesthesia care unit (p = 0.004) and hospital stay (p < 0.001).ConclusionsThis meta-analysis suggests that ePND is associated with a doubled risk of mortality and with a 9-fold increased risk of postoperative delirium.
- Добавил в систему: Ядгаров Михаил Яковлевич