Table 1 Characteristics of the studies included in the meta-analysis (n = 43)
Participants | Exposures/interventions | Comparison | Outcome (frailty) | Outcome (non-frailty) | |||||
|---|---|---|---|---|---|---|---|---|---|
Author, year Country No. of patients/No. of male patients Age/Age criterion Mean ± SD or median (IQR) age Type of surgery | Frailty measure category | Delirium measure category | Comparator | Delirium | Total | Delirium | Total | ||
Tsai 2023[40] China, Taiwan 345/206 ≥ 65 years 73 years (65–99 years) Elective abdominal surgery | CGA | CAM | Fit group: n = 159 (46.1%) Frail group: n = 186 (53.9%) | 15 | 186 | 4 | 159 | ||
Tian 2023[26] China 1372 /781 > 65 years Not mentioned Elective lung cancer surgery | mFI | DSM-V | Frail group: n = 388 (mFI-5, 2–5), Pre-frail group: n = 503 (mFI-5, 1) Robust group: n = 481 (mFI-5, 0) | 121 | 388 | 15 | 984 | ||
Tomoyuki Sugi, 2023[27] Japan 158 /111 ≥ 75 years 79 years (75–91 years) Gastroenterological surgery | Fried | CAM | Postoperative delirium (+): n = 53 Postoperative delirium (−): n = 105 | 27 | 48 | 26 | 110 | ||
J. Steenblock 2023[28] Germany 701/367 ≥ 70 years 77.1 ± 4.7 years Elective surgery | FI | A combination of I-CAM and chart review | Non-frail group: n = 173 Frail group: n = 528 | 134 | 528 | 31 | 173 | ||
Hunter 2023[29] Australia 300/89 > 50 years 81.1 ± 9.8 years Hip fracture surgery | CFS | 3D-CAM | CFS ≥ 5: n = 160 CFS < 5: n = 121 | 66 | 164 | 16 | 135 | ||
Gandossi 2023[30] Italy 984/241 > 65 years 84 years (79–89 years) Urgent surgery | FI | 4AT | FI < 0.25: n = 504 FI ≥ 0.25: n = 480 | 228 | 480 | 83 | 504 | ||
Abdelfatah 2023[31] USA 411/203 > 65 years 75.1 ± 6.60 years Colorectal resection | RAI-A | ICD-9 ICD-10 | Not frail: 42/288 (14.6%) Frail: 37/123 (30.1%) | 6 | 123 | 2 | 288 | ||
Zhao 2022[66] China 381/98 ≥ 65 years High CFI group: 83 ± 5 years Low CFI group: 78 ± 7 years Hip fracture repair surgery | CFI | CAM | High CFI group: n = 102 Low CFI group: n = 279 | 17 | 102 | 8 | 279 | ||
Xiang 2022[33] China 226/Not mentioned 65–85 years No POD: 70.4 ± 2.7 years POD: 71.7 ± 3.0 years Laparoscopic surgery for gynecologic cancers | mFI | DSM-V | POD No: n = 187 Yes: n = 39 | 10 | 31 | 29 | 195 | ||
Sieber 2022[67] USA 324/196 ≥ 65 years 4AT < 4: 73.1 ± 6.2 years 4AT ≥ 4: 77.5 ± 6.3 years Elective surgery | EFS | 4AT | 4AT < 4: n = 309 4AT ≥ 4: n = 15 | 10 | 83 | 5 | 241 | ||
Musacchio 2022[35] Italy 244/39 ≥ 65 years 85 ± 6.9 years Hip fracture surgery | MPI | 4AT | Delirium: n = 104 No delirium: n = 140 | 76 | 143 | 28 | 101 | ||
Esmaeeli 2021[36] USA 557/169 ≥ 65 years POD: 85 ± 7 years No POD: 80 ± 8 years Orthopedic trauma patients | FRAIL | CAM | POD: n = 80 No POD: n = 477 | 4 | 18 | 76 | 539 | ||
Thillainadesan 2021[70] USA 150/102 ≥ 65 years 79.5 years (7.7 years) Vascular surgery | CFS FI | CAM | Frail: n = 34 Fit: n = 116 CFS ≥ 5: n = 45 CFS < 5: n = 105 | 10 | 45 | 5 | 105 | ||
Pedemonte 2021[38] USA 558/165 ≥ 65 years 80.16 years (8.57 years) Orthopedic trauma patients | FRAIL | CAM | Robust: n = 166 Pre-frail: n = 217 Frail: n = 126 | 25 | 126 | 24 | 217 | ||
Mauri 2021[39] Germany 661/322 Not mentioned 82.3 ± 6.6 years TAVR | EFT | CAM-ICU | Delirium: n = 66 No delirium: n = 595 | 46 | 199 | 20 | 462 | ||
Gandossi 2021[30] Italy 988/250 ≥ 65 years 84.9 years (80.6–89.2 years) Hip fracture surgery | FI | 4AT DSM-5 | FI < 0.25: n = 628 FI ≥ 0.25: n = 360 | 183 | 360 | 228 | 628 | ||
Cheng 2021[41] China, Taiwan 152/104 ≥ 20 years 63.07 years (11.17 years) Cardiac surgery | Fried | CAM | Non-delirium: n = 5142 Delirium: n = 510 | 2 | 21 | 8 | 131 | ||
Chen 2021[24] China 383/132 65–85 years 73.2 ± 3.3 years Elective total joint arthroplasty | mFI | DSM-V | High mFI (> 0.18): n = 207 Low mFI (< 0.18): n = 176 | 44 | 207 | 22 | 176 | ||
Banning 2021[42] The Netherlands 639/497 Not mentioned 69.4 ± 10.0 Elective vascular surgery | GFI | Not mentioned | Frail: n = 183 (28.6%) Non-frail: n = 456 (71.4%) | 17 | 183 | 27 | 456 | ||
Ishihara 2020[43] Japan 295/216 ≥ 65 years 74 years (65–89 years) Hepatic resection | KCL | ICDSC | Delirium group: n = 22 Non-delirium group: n = 273 | 10 | 15 | 12 | 295 | ||
Susano 2020[44] Portugal 219/124 ≥ 70 years 75 years (73–79 years) Elective spine surgery | FRAIL | CAM | No POD: n = 164 (75%) POD: n = 55 (25%) | 24 | 53 | 31 | 166 | ||
Saljuqi 2020[25] USA 163/85 ≥ 65 years 71 ± 7 years Emergency general surgery | ESFI | CAM | Delirium: n = 38 No delirium: n = 107 | 15 | 30 | 23 | 80 | ||
Sanchez 2020[45] Spain 446/198 ≥ 65 years 78 years (65–103 years) Urgent abdominal surgery | FRAIL | CAM | No delirium: n = 385 Delirium: n = 61 | 18 | 59 | 43 | 387 | ||
Nakano 2020[46] Japan 133/97 ≥ 55 years Non-frail: 71.3 ± 7.1 years Frail: 73.5 ± 8.1 years Cardiac surgery | Fried | CAM | Non-frail: n = 89 Frail: n = 44 | 19 | 44 | 37 | 89 | ||
Mahanna-Gabrielli 2020[47] USA 178/75 ≥ 65 years Robust: 70 years (67–74.5 years) Prefrail: 70.5 years (67–75 years) Frail: 71 years (66–74 years) Non-cardiac surgery | FRAIL | CAM-ICU | Robust: n = 64 Pre-frail: n = 72 Frail: n = 31 | 11 | 31 | 27 | 106 | ||
Goudzwaard 2020[48] The Netherlands 543/297 Not mentioned 79.1 ± 8.0 years TAVI | EFS | DSM-IV | Delirium: n = 75 No delirium: n = 468 | 24 | 97 | 51 | 446 | ||
Atsunori Itagaki 2020[49] Japan 114/73 ≥ 65 years 74.9 ± 5.5 years Cardiac surgery | J-CHS | ICDSC | Non-frailty, non-MCI: n = 23 Non-frailty, MCI: n = 32 Frailty, non-MCI: n = 11 Frailty, MCI: n = 23 | 21 | 72 | 4 | 17 | ||
Chan 2019[64] Canada 423/267 ≥ 65 years 82.5 ± 8.4 years Total arthroplasty, hemiarthroplasty, dynamic hip or cannulated screws, intramedullary nail | CFS | A validated chart-abstraction instrument | Not frail (CFS 1–3): n = 71 Vulnerable (CFS 4): n = 72 Mildly frail (CFS 5): n = 92 Frail (CFS 6–9): n = 187 | 211 | 279 | 50 | 143 | ||
Saravana-Bawan 2019[50] Canada 322/176 ≥ 65 years 76.1 ± 7.66 years Intestinal, appendix, gallbladder, or hernia repair surgery | CFS | Inouye chart review method | No delirium: n = 249 Delirium: n = 73 | 33 | 78 | 40 | 244 | ||
Goudzwaard 2019[48] The Netherlands 213/46.5% Not mentioned 82.03 years (78.2–85.6 years) TAVI | EFS | DSM-IV | Non-frail: n = 153 Frail (EFS ≥ 3): n = 60 | 27 | 61 | 15 | 152 | ||
Nomura 2019[51] USA 133/97 ≥ 65 years 69.33 ± 7.90 years CABG, valve procedures, or other surgery | Fried | CAM | Non-frail: n = 15 Pre-frail: n = 74 Frail: n = 44 | 19 | 40 | 37 | 88 | ||
Haugen 2018[52] USA 893/545 Not mentioned 50.3 ± 13.7 years KT | Fried | A validated instrument for chart review | No delirium: n = 851 Delirium: n = 42 | 13 | 146 | 29 | 747 | ||
Tanaka 2018[53] Japan 217/149 ≥ 65 years Non-frail: 75 years (65–88 years); Frail: 72 years (65–88 years) Hepatic resection | KCL | ICDSC | Frail group: n = 63 Non-frail group: n = 154 | 8 | 63 | 3 | 154 | ||
Bagienski 2017[54] Poland 141/52 ≥ 75 years 82.0 years (77.5–85.0 years) TAVI | FI | CHART DEL | No delirium: n = 112 Delirium: n = 29 | 15 | 47 | 14 | 94 | ||
Brown 2016[55] USA 55/41 ≥ 55 years Non-frail: 64.7 ± 5.6 years; Frail: 67.7 ± 8.4 years CABG | Fried | CAM | Non-frail: n = 38 Frail: n = 17 | 8 | 17 | 1 | 38 | ||
Assmann 2016[56] The Netherlands 89/47 ≥ 75 years 80.4 years (6.3 years) MT, SAVR, TAVI | FI | DSM-IV | No delirium: n = 64 Delirium: n = 25 | 15 | 47 | 10 | 42 | ||
Khan 2016[74] Singapore 25/17 ≥ 65 years 79 years (74–83 years) Femur fracture fixation surgery, abdominal laparotomy; total knee replacement | Fried | CAM-ICU | Nonfrail: n = 11 Frail: n = 14 | 1 | 14 | 1 | 11 | ||
Eide 2015[58] Norway 143/62 ≥ 80 years 83.5 ± 2.7 years TAVI, SAVR | FI | CAM DSM-IV | No delirium: n = 60 Delirium: n = 76 | 32 | 56 | 44 | 87 | ||
Jung 2015[59] Canada 133/98 ≥ 18 years Non-frail: 68.7 ± 7.4 years; Frail: 73.0 ± 8.2 years CABG, valve procedures | Fried | CAM-ICU, CAM | Non-frail: n = 61 Frail: n = 72 | 20 | 72 | 5 | 61 | ||
Kistler 2015[60] USA 35/6 ≥ 65 years 86 ± 4 years Hip fracture surgery | Fried | CAM | Frail: n = 18 Non-frail: n = 17 | 10 | 18 | 4 | 17 | ||
Partridge 2015[61] UK 125/86 ≥ 60 years 76.3 ± 7.27 years Arterial vascular surgery | EFS | CAM | EFS < 6.5: n = 60 (48.0%) EFS > 6.5: n = 65 (52.0%) | 15 | 65 | 9 | 60 | ||
Leung 2011[62] USA 63/29 ≥ 65 years Delirium: 74.2 ± 6.0 years; No delirium: 71.9 ± 6.3 years General, arthroplasty, spine, or thoracic surgery | EFS | CAM | Delirium: n = 16 No delirium: n = 47 | 9 | 21 | 7 | 32 | ||
Pol 2011[63] The Netherlands 142/100 21–87 years 68 ± 11 years Vascular surgery | GFI | DSM-IV-TR | GFI > 4: n = 50 GFI ≤ 4: n = 92 | 6 | 50 | 4 | 92 | ||