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Risk factors for incident delirium among urological patients: a systematic review and meta-analysis with GRADE summary of findings

Research output: Contribution to journalArticle

Leigh Sanyaolu, A Scholz, I Mayo, J Coode-Bate, C Oldroyd, Ben Carter, Terry J. Quinn, Jonathan Hewitt

Original languageEnglish
JournalBMC Urology
Accepted/In press13 Oct 2020


  • Final Manuscript

    Final_Manuscript.docx, 1.63 MB, application/vnd.openxmlformats-officedocument.wordprocessingml.document

    Uploaded date:13 Oct 2020

    Version:Accepted author manuscript

King's Authors


Background: Post-operative delirium is an important, yet under-researched complication of surgery. Patients undergoing urological surgery may be at especially high risk of POD, as they are often older, and interventions can be associated with conditions that trigger delirium. The main aim of this systematic review was to evaluate the available evidence for risk factors in this patient group. Methods: Five databases were searched (MEDLINE, Web of Science, EMBASE, CINAHL & PsychInfo) between January 1987 and June 2019. The Newcastle-Ottawa Scale (NOS) was used to assess for risk of bias. Pooled odds ratio (OR) or mean difference (MD) for individual risk factors were estimated using the Mantel-Haenzel and inverse variance methods. Results: Seven articles met the inclusion criteria, giving a total population of 1937. The incidence of POD ranged from 5-29%. Three studies were deemed low risk of bias and four at a high risk of bias. Nine risk factors were suitable for meta-analysis, with age (MD 4.314 95% CI 1.597, 7.032 p=0.002) and the clock drawing test (MD -2.443 95% CI -3.029, -1.857 p<0.001) having a statistically significant association with POD in pooled analyses. Conclusion: Delirium is common in urological patients. This review has identified a lack of studies in this surgical population, with wide heterogeneity and high risk of bias. It also highlights a number of potential risk factors for post-operative delirium, of which some are modifiable. However, the strength of evidence is weak at present and so future research should focus on assessing comparable risk factors in this patient group in order to inform future clinical practice.

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