Risk factors of postoperative delirium after pneumonectomy: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YE Lei ¹ , WU Guanghong ¹ , DING Jiefang ² , WANG Qin ² ,  XIA Guanghui ¹

1. Department of Nursing, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, P. R. China;
2. Department of Thoracic Surgery, Affiliated Brain Hospital of Nanjing Medical University Nanjing, 210029, P. R. China;

Corresponding author：

XIA Guanghui, Email: xgh4290@163.com

Keywords：

Pneumonectomy; postoperative delirium; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202411060

Video：

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Objective To systematically evaluate the risk factors for postoperative delirium (POD) in patients undergoing lung resection. Methods PubMed, Web of Science, The Cochrane Library, CNKI, Wanfang, and VIP databases were searched from the inception to November 7, 2024 for cross-sectional studies, case-control studies, and cohort studies on POD in patients undergoing lung resection. Two researchers independently screened the literature, extracted data, and evaluated the quality of the literature. RevMan 5.4.1 software was used for meta-analysis. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the literature. Results A total of 12 studies were included, with 5 574 patients. The quality scores of the literature were all ≥6 points. Meta-analysis results showed that age (≥60 years) [OR=2.43, 95%CI (2.01, 2.93), P<0.01], ASA classification (Ⅳ) [OR=8.74, 95%CI (5.23, 14.61), P<0.01], history of diabetes [OR=12.81, 95%CI (10.45, 15.71), P<0.01], history of cerebrovascular disease [OR=3.00, 95%CI (2.46, 3.67), P<0.01], depression [OR=7.27, 95%CI (5.46, 9.67), P<0.01], squamous cell carcinoma [OR=4.79, 95%CI (1.83, 12.51), P<0.01], malnutrition [OR=5.25, 95%CI (3.35, 8.25), P<0.01], sleep disorders [OR=2.79, 95%CI (2.28, 3.42), P<0.01], and duration of one-lung ventilation during surgery [OR=1.32, 95%CI (1.11, 1.57), P<0.01] are all risk factors for POD, while high body mass index [OR=0.96, 95%CI (0.95, 0.97), P<0.01] is a protective factor for POD. Conclusion Age (≥60 years), ASA classification (Ⅳ), history of diabetes, history of cerebrovascular disease, depression, squamous cell carcinoma, malnutrition, sleep disorders, and duration of one-lung ventilation during surgery are independent risk factors for POD, while high BMI is a protective factor.

1.	Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
2.	Li N, Tan F, Chen W, et al. One-off low-dose CT for lung cancer screening in China: A multicentre, population-based, prospective cohort study. Lancet Respir Med, 2022, 10(4): 378-391.
3.	Cheng AM, Wood DE. VATS versus open surgery for lung cancer resection: Moving beyond the incision. J Natl Compr Canc Netw, 2015, 13(2): 166-170.
4.	Liu Z, Jin Y, Wang L, et al. The effect of ciprofol on postoperative delirium in elderly patients undergoing thoracoscopic surgery for lung cancer: A prospective, randomized, controlled trial. Drug Des Devel Ther, 2024, 18: 325-339.
5.	中国老年医学学会麻醉学分会. 中国老年患者术后谵妄防治专家共识. 国际麻醉学与复苏杂志, 2023, 44(1): 1-27.Anaesthesiology Branch of the Chinese Society of Geriatrics. Consensus on the prevention and treatment of postoperative delirium in elderly patients in China. J Anaesth Resusc, 2023, 44(1): 1-27.
6.	陈军, 车国卫, 孙大强, 等. 老年肺癌外科治疗中国专家共识 (2022版). 中国肺癌杂志, 2023, 26(2): 83-92.Chen J, Che GW, Sun DQ, et al. Consensus of Chinese experts on surgical treatment of lung cancer in the elderly (2022 edition). Chin J Cancer, 2023, 26(2): 83-92.
7.	Zhang CJ, Ma JH, Jin F, et al. Effect of one-lung ventilation on the correlation between left and right cerebral saturation. BMC Anesthesiol, 2023, 23(1): 50.
8.	Ishibashi H, Wakejima R, Asakawa A, et al. Postoperative delirium in lung cancer anatomical resection: Analysis of risk factors and prognosis. World J Surg, 2022, 46(5): 1196-1206.
9.	Hayashi K, Motoishi M, Sawai S, et al. Postoperative delirium after lung resection for primary lung cancer: Risk factors, risk scoring system, and prognosis. PLoS One, 2019, 14(11): e0223917.
10.	谭文斐, 郭冰, 金凤, 等. 肺叶切除术患者术后谵妄的危险因素分析. 临床麻醉学杂志, 2016, 32(9): 923-924.Tan WF, Guo B, Jin F, et al. Analysis of risk factors for postoperative delirium in patients undergoing lobectomy. J Clin Anaesthesiol, 2016, 32(9): 923-924.
11.	尚明煦, 魏丽娟, 是若春. 血清甲状腺激素、NLR及CRP/ALB与肺癌术后谵妄的关系. 分子诊断与治疗杂志, 2024, 16(1): 174-177,182.Shang MX, Wei LJ, Shi RC. Relationship between serum thyroid hormone, NLR and CRP/ALB and delirium after lung cancer surgery. J Mol Diagn Ther, 2024, 16(1): 174-177,182.
12.	刘微, 关丹丹, 张洪岩. 老年肺癌患者胸腔镜下根治切除术后谵妄发生的列线图模型的建立与评价. 现代肿瘤医学, 2024, 32(6): 1054-1059.Liu W, Guan DD, Zhang HY. Establishment and evaluation of a nomogram model for delirium occurrence after thoracoscopic radical resection in elderly lung cancer patients. Mod Oncol Med, 2024, 32(6): 1054-1059.
13.	Lu Y, Liu X. Postoperative delirium and its influencing factors in elderly patients with lung cancer in the intensive care unit. J Thorac Dis, 2023, 15(2): 701-710.
14.	Tian JY, Hao XY, Cao FY, et al. Preoperative frailty assessment predicts postoperative mortality, delirium and pneumonia in elderly lung cancer patients: A retrospective cohort study. Ann Surg Oncol, 2023, 30(12): 7442-7451.
15.	李繁, 黎仕焕, 谢爽. 老年患者肺癌根治术后谵妄的危险因素及列线图预测模型的建立. 临床麻醉学杂志, 2022, 38(10): 1013-1019.Li F, Li SH, Xie S. Risk factors and nomogram prediction model establishment for concurrent postoperative delirium in elderly patients undergoing radical resection of lung cancer. J Clin Anaesthesiol, 2022, 38(10): 1013-1019.
16.	郑红, 陈晓霞, 韩李周, 等. 老年肺叶切除术前血浆MMP-9、C1q及脂联素变化与术后谵妄的相关性. 锦州医科大学学报, 2022, 43(2): 70-74.Zheng H, Chen XX, Han LZ, et al. Correlation of preoperative changes in plasma MMP-9, C1q and adiponectin with postoperative delirium in elderly patients undergoing lobectomy. J Jinzhou Med Univ, 2022, 43(2): 70-74.
17.	许海阳, 刘红, 应笑丽, 等. 肺癌患者根治术后谵妄的危险因素分析. 中国现代医生, 2021, 59(33): 102-104,108.Xu HY, Liu H, Ying XL, et al. Analysis of risk factors for delirium in patients with radical surgery for lung cancer. China Mod Physician, 2021, 59(33): 102-104,108.
18.	陈士欢. 老年患者行胸腔镜下肺癌根治术后谵妄危险因素研究. 河北北方学院, 2021.Chen SH. Risk factors for delirium after thoracoscopic radical lung cancer surgery in elderly patients. Hebei North College, 2021.
19.	Cui F, Zhao W, Mu DL, et al. Association between cerebral desaturation and postoperative delirium in thoracotomy with one-lung ventilation: A prospective cohort study. Anesth Analg, 2021, 133(1): 176-186.
20.	Bai J, Liang Y, Zhang P, et al. Association between postoperative delirium and mortality in elderly patients undergoing hip fractures surgery: A meta-analysis. Osteoporos Int, 2020, 31(2): 317-326.
21.	Noah AM, Almghairbi D, Evley R, et al. Preoperative inflammatory mediators and postoperative delirium: Systematic review and meta-analysis. Br J Anaesth, 2021, 127(3): 424-434.
22.	Liu R, Liu N, Suo S, et al. Incidence and risk factors of postoperative delirium following hepatic resection: A retrospective national inpatient sample database study. BMC Surg, 2024, 24(1): 151.
23.	Root JC, Pryor KO, Downey R, et al. Association of pre-operative brain pathology with post-operative delirium in a cohort of non-small cell lung cancer patients undergoing surgical resection. Psychooncology, 2013, 22(9): 2087-2094.
24.	Diep C, Patel K, Petricca J, et al. Incidence and relative risk of delirium after major surgery for patients with pre-operative depression: A systematic review and meta-analysis. Anaesthesia, 2024, 79(11): 1237-1249.
25.	Drevets WC, Price JL, Furey ML. Brain structural and functional abnormalities in mood disorders: Implications for neurocircuitry models of depression. Brain Struct Funct, 2008, 213(1-2): 93-118.
26.	Maclullich AM, Ferguson KJ, Miller T, et al. Unravelling the pathophysiology of delirium: A focus on the role of aberrant stress responses. J Psychosom Res, 2008, 65(3): 229-238.
27.	Ko Y, Kim HE, Park JY, et al. Relationship between body mass index and risk of delirium in an intensive care unit. Arch Gerontol Geriatr, 2023, 108: 104921.
28.	Parini S, Azzolina D, Massera F, et al. The overweight paradox: Impact of body mass index on patients undergoing VATS lobectomy or segmentectomy. Semin Thorac Cardiovasc Surg, 2023, 35(1): 164-176.
29.	Qu C, Li R, Ma Z, et al. Comparison of the perioperative outcomes between robotic-assisted thoracic surgery and video-assisted thoracic surgery in non-small cell lung cancer patients with different body mass index ranges. Transl Lung Cancer Res, 2022, 11(6): 1108-1118.
30.	Bellelli G, Zambon A, Volpato S, et al. The association between delirium and sarcopenia in older adult patients admitted to acute geriatrics units: Results from the GLISTEN multicenter observational study. Clin Nutr, 2018, 37(5): 1498-1504.
31.	刘静, 雷佩, 王娟, 等. 衰弱对老年肺癌患者术后谵妄、吸入性肺炎和短期预后的预测价值. 老年医学与保健, 2024, 30(4): 935-940.Liu J, Lei P, Wang J, et al. Predictive value of frailty on postoperative delirium, aspiration pneumonia and short-term prognosis in elderly lung cancer patients. Geriatr Healthc, 2024, 30(4): 935-940.
32.	Sedgwick P, Marston L. How to read a funnel plot in a meta-analysis. BMJ, 2015, 351: h4718.

1. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
2. Li N, Tan F, Chen W, et al. One-off low-dose CT for lung cancer screening in China: A multicentre, population-based, prospective cohort study. Lancet Respir Med, 2022, 10(4): 378-391.
3. Cheng AM, Wood DE. VATS versus open surgery for lung cancer resection: Moving beyond the incision. J Natl Compr Canc Netw, 2015, 13(2): 166-170.
4. Liu Z, Jin Y, Wang L, et al. The effect of ciprofol on postoperative delirium in elderly patients undergoing thoracoscopic surgery for lung cancer: A prospective, randomized, controlled trial. Drug Des Devel Ther, 2024, 18: 325-339.
5. 中国老年医学学会麻醉学分会. 中国老年患者术后谵妄防治专家共识. 国际麻醉学与复苏杂志, 2023, 44(1): 1-27.Anaesthesiology Branch of the Chinese Society of Geriatrics. Consensus on the prevention and treatment of postoperative delirium in elderly patients in China. J Anaesth Resusc, 2023, 44(1): 1-27.
6. 陈军, 车国卫, 孙大强, 等. 老年肺癌外科治疗中国专家共识 (2022版). 中国肺癌杂志, 2023, 26(2): 83-92.Chen J, Che GW, Sun DQ, et al. Consensus of Chinese experts on surgical treatment of lung cancer in the elderly (2022 edition). Chin J Cancer, 2023, 26(2): 83-92.
7. Zhang CJ, Ma JH, Jin F, et al. Effect of one-lung ventilation on the correlation between left and right cerebral saturation. BMC Anesthesiol, 2023, 23(1): 50.
8. Ishibashi H, Wakejima R, Asakawa A, et al. Postoperative delirium in lung cancer anatomical resection: Analysis of risk factors and prognosis. World J Surg, 2022, 46(5): 1196-1206.
9. Hayashi K, Motoishi M, Sawai S, et al. Postoperative delirium after lung resection for primary lung cancer: Risk factors, risk scoring system, and prognosis. PLoS One, 2019, 14(11): e0223917.
10. 谭文斐, 郭冰, 金凤, 等. 肺叶切除术患者术后谵妄的危险因素分析. 临床麻醉学杂志, 2016, 32(9): 923-924.Tan WF, Guo B, Jin F, et al. Analysis of risk factors for postoperative delirium in patients undergoing lobectomy. J Clin Anaesthesiol, 2016, 32(9): 923-924.
11. 尚明煦, 魏丽娟, 是若春. 血清甲状腺激素、NLR及CRP/ALB与肺癌术后谵妄的关系. 分子诊断与治疗杂志, 2024, 16(1): 174-177,182.Shang MX, Wei LJ, Shi RC. Relationship between serum thyroid hormone, NLR and CRP/ALB and delirium after lung cancer surgery. J Mol Diagn Ther, 2024, 16(1): 174-177,182.
12. 刘微, 关丹丹, 张洪岩. 老年肺癌患者胸腔镜下根治切除术后谵妄发生的列线图模型的建立与评价. 现代肿瘤医学, 2024, 32(6): 1054-1059.Liu W, Guan DD, Zhang HY. Establishment and evaluation of a nomogram model for delirium occurrence after thoracoscopic radical resection in elderly lung cancer patients. Mod Oncol Med, 2024, 32(6): 1054-1059.
13. Lu Y, Liu X. Postoperative delirium and its influencing factors in elderly patients with lung cancer in the intensive care unit. J Thorac Dis, 2023, 15(2): 701-710.
14. Tian JY, Hao XY, Cao FY, et al. Preoperative frailty assessment predicts postoperative mortality, delirium and pneumonia in elderly lung cancer patients: A retrospective cohort study. Ann Surg Oncol, 2023, 30(12): 7442-7451.
15. 李繁, 黎仕焕, 谢爽. 老年患者肺癌根治术后谵妄的危险因素及列线图预测模型的建立. 临床麻醉学杂志, 2022, 38(10): 1013-1019.Li F, Li SH, Xie S. Risk factors and nomogram prediction model establishment for concurrent postoperative delirium in elderly patients undergoing radical resection of lung cancer. J Clin Anaesthesiol, 2022, 38(10): 1013-1019.
16. 郑红, 陈晓霞, 韩李周, 等. 老年肺叶切除术前血浆MMP-9、C1q及脂联素变化与术后谵妄的相关性. 锦州医科大学学报, 2022, 43(2): 70-74.Zheng H, Chen XX, Han LZ, et al. Correlation of preoperative changes in plasma MMP-9, C1q and adiponectin with postoperative delirium in elderly patients undergoing lobectomy. J Jinzhou Med Univ, 2022, 43(2): 70-74.
17. 许海阳, 刘红, 应笑丽, 等. 肺癌患者根治术后谵妄的危险因素分析. 中国现代医生, 2021, 59(33): 102-104,108.Xu HY, Liu H, Ying XL, et al. Analysis of risk factors for delirium in patients with radical surgery for lung cancer. China Mod Physician, 2021, 59(33): 102-104,108.
18. 陈士欢. 老年患者行胸腔镜下肺癌根治术后谵妄危险因素研究. 河北北方学院, 2021.Chen SH. Risk factors for delirium after thoracoscopic radical lung cancer surgery in elderly patients. Hebei North College, 2021.
19. Cui F, Zhao W, Mu DL, et al. Association between cerebral desaturation and postoperative delirium in thoracotomy with one-lung ventilation: A prospective cohort study. Anesth Analg, 2021, 133(1): 176-186.
20. Bai J, Liang Y, Zhang P, et al. Association between postoperative delirium and mortality in elderly patients undergoing hip fractures surgery: A meta-analysis. Osteoporos Int, 2020, 31(2): 317-326.
21. Noah AM, Almghairbi D, Evley R, et al. Preoperative inflammatory mediators and postoperative delirium: Systematic review and meta-analysis. Br J Anaesth, 2021, 127(3): 424-434.
22. Liu R, Liu N, Suo S, et al. Incidence and risk factors of postoperative delirium following hepatic resection: A retrospective national inpatient sample database study. BMC Surg, 2024, 24(1): 151.
23. Root JC, Pryor KO, Downey R, et al. Association of pre-operative brain pathology with post-operative delirium in a cohort of non-small cell lung cancer patients undergoing surgical resection. Psychooncology, 2013, 22(9): 2087-2094.
24. Diep C, Patel K, Petricca J, et al. Incidence and relative risk of delirium after major surgery for patients with pre-operative depression: A systematic review and meta-analysis. Anaesthesia, 2024, 79(11): 1237-1249.
25. Drevets WC, Price JL, Furey ML. Brain structural and functional abnormalities in mood disorders: Implications for neurocircuitry models of depression. Brain Struct Funct, 2008, 213(1-2): 93-118.
26. Maclullich AM, Ferguson KJ, Miller T, et al. Unravelling the pathophysiology of delirium: A focus on the role of aberrant stress responses. J Psychosom Res, 2008, 65(3): 229-238.
27. Ko Y, Kim HE, Park JY, et al. Relationship between body mass index and risk of delirium in an intensive care unit. Arch Gerontol Geriatr, 2023, 108: 104921.
28. Parini S, Azzolina D, Massera F, et al. The overweight paradox: Impact of body mass index on patients undergoing VATS lobectomy or segmentectomy. Semin Thorac Cardiovasc Surg, 2023, 35(1): 164-176.
29. Qu C, Li R, Ma Z, et al. Comparison of the perioperative outcomes between robotic-assisted thoracic surgery and video-assisted thoracic surgery in non-small cell lung cancer patients with different body mass index ranges. Transl Lung Cancer Res, 2022, 11(6): 1108-1118.
30. Bellelli G, Zambon A, Volpato S, et al. The association between delirium and sarcopenia in older adult patients admitted to acute geriatrics units: Results from the GLISTEN multicenter observational study. Clin Nutr, 2018, 37(5): 1498-1504.
31. 刘静, 雷佩, 王娟, 等. 衰弱对老年肺癌患者术后谵妄、吸入性肺炎和短期预后的预测价值. 老年医学与保健, 2024, 30(4): 935-940.Liu J, Lei P, Wang J, et al. Predictive value of frailty on postoperative delirium, aspiration pneumonia and short-term prognosis in elderly lung cancer patients. Geriatr Healthc, 2024, 30(4): 935-940.
32. Sedgwick P, Marston L. How to read a funnel plot in a meta-analysis. BMJ, 2015, 351: h4718.

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