Do Risk Prediction Models for Postoperative Delirium Consider Patients’ Preoperative Medication Use?
Background Medicines are potentially modifiable risk factors for postoperative delirium. However, the extent to which preoperative medicines are included in risk prediction models (RPMs) is unknown. Objective This systematic review aimed to assess the extent of inclusion of preoperative medications...
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Veröffentlicht in: | Drugs & aging 2018-03, Vol.35 (3), p.213-222 |
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description | Background
Medicines are potentially modifiable risk factors for postoperative delirium. However, the extent to which preoperative medicines are included in risk prediction models (RPMs) is unknown.
Objective
This systematic review aimed to assess the extent of inclusion of preoperative medications in RPMs for postoperative delirium.
Methods
Articles were systematically searched from MEDLINE, EMBASE and CINAHL using Medical Subject Headings (MeSH) where possible and keywords for postoperative delirium and prediction model. Studies published until May 2017 with a primary outcome of postoperative delirium that developed an RPM containing preoperative patient information were considered. Where a study had two cohorts, a derivation and a validation cohort, findings from the derivation cohort were extracted and reported.
Results
Eighteen prospective and one retrospective cohort studies were included for review. Of the 19 studies, only nine considered preoperative medication data, with medications appearing as predictor variables in five models. There was wide variability in the factors included in the final models, with the most frequent predictors being age and cognitive impairment, appearing in 13 (68%) and 11 (58%) RPMs, respectively.
Conclusion
While medications are commonly cited risk factors for delirium, they are not adequately considered when developing RPMs. Future studies aiming to develop an RPM for postoperative delirium should include preoperative medication data as a potential predictor variable because of the modifiable nature of medication use and its impact on other factors commonly in models, such as cognition. |
doi_str_mv | 10.1007/s40266-018-0526-6 |
format | Article |
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Medicines are potentially modifiable risk factors for postoperative delirium. However, the extent to which preoperative medicines are included in risk prediction models (RPMs) is unknown.
Objective
This systematic review aimed to assess the extent of inclusion of preoperative medications in RPMs for postoperative delirium.
Methods
Articles were systematically searched from MEDLINE, EMBASE and CINAHL using Medical Subject Headings (MeSH) where possible and keywords for postoperative delirium and prediction model. Studies published until May 2017 with a primary outcome of postoperative delirium that developed an RPM containing preoperative patient information were considered. Where a study had two cohorts, a derivation and a validation cohort, findings from the derivation cohort were extracted and reported.
Results
Eighteen prospective and one retrospective cohort studies were included for review. Of the 19 studies, only nine considered preoperative medication data, with medications appearing as predictor variables in five models. There was wide variability in the factors included in the final models, with the most frequent predictors being age and cognitive impairment, appearing in 13 (68%) and 11 (58%) RPMs, respectively.
Conclusion
While medications are commonly cited risk factors for delirium, they are not adequately considered when developing RPMs. Future studies aiming to develop an RPM for postoperative delirium should include preoperative medication data as a potential predictor variable because of the modifiable nature of medication use and its impact on other factors commonly in models, such as cognition.</description><identifier>ISSN: 1170-229X</identifier><identifier>EISSN: 1179-1969</identifier><identifier>DOI: 10.1007/s40266-018-0526-6</identifier><identifier>PMID: 29423780</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Bone surgery ; Clinical practice guidelines ; Cognitive ability ; Delirium ; Delirium - chemically induced ; Delirium - etiology ; Delirium - prevention & control ; Epidemiology ; Fractures ; Geriatrics/Gerontology ; Gerontology ; Health risk assessment ; Health services ; Heart surgery ; Hospitals ; Humans ; Internal Medicine ; Intervention ; Medicine ; Medicine & Public Health ; Models, Statistical ; Neck ; Older people ; Patients ; Pharmacology/Toxicology ; Pharmacotherapy ; Postoperative Complications - chemically induced ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Predictive Value of Tests ; Prevention ; Prospective Studies ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Subject heading schemes ; Systematic Review</subject><ispartof>Drugs & aging, 2018-03, Vol.35 (3), p.213-222</ispartof><rights>Springer International Publishing AG, part of Springer Nature 2018</rights><rights>Copyright Springer Science & Business Media Mar 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-6b6cf5995a61611b2b5b25efb3a587aced6ac0becab87b5a2f2f79233d8a613a3</citedby><cites>FETCH-LOGICAL-c372t-6b6cf5995a61611b2b5b25efb3a587aced6ac0becab87b5a2f2f79233d8a613a3</cites><orcidid>0000-0003-4286-3771</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40266-018-0526-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40266-018-0526-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29423780$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kassie, Gizat M.</creatorcontrib><creatorcontrib>Nguyen, Tuan A.</creatorcontrib><creatorcontrib>Kalisch Ellett, Lisa M.</creatorcontrib><creatorcontrib>Pratt, Nicole L.</creatorcontrib><creatorcontrib>Roughead, Elizabeth E.</creatorcontrib><title>Do Risk Prediction Models for Postoperative Delirium Consider Patients’ Preoperative Medication Use?</title><title>Drugs & aging</title><addtitle>Drugs Aging</addtitle><addtitle>Drugs Aging</addtitle><description>Background
Medicines are potentially modifiable risk factors for postoperative delirium. However, the extent to which preoperative medicines are included in risk prediction models (RPMs) is unknown.
Objective
This systematic review aimed to assess the extent of inclusion of preoperative medications in RPMs for postoperative delirium.
Methods
Articles were systematically searched from MEDLINE, EMBASE and CINAHL using Medical Subject Headings (MeSH) where possible and keywords for postoperative delirium and prediction model. Studies published until May 2017 with a primary outcome of postoperative delirium that developed an RPM containing preoperative patient information were considered. Where a study had two cohorts, a derivation and a validation cohort, findings from the derivation cohort were extracted and reported.
Results
Eighteen prospective and one retrospective cohort studies were included for review. Of the 19 studies, only nine considered preoperative medication data, with medications appearing as predictor variables in five models. There was wide variability in the factors included in the final models, with the most frequent predictors being age and cognitive impairment, appearing in 13 (68%) and 11 (58%) RPMs, respectively.
Conclusion
While medications are commonly cited risk factors for delirium, they are not adequately considered when developing RPMs. Future studies aiming to develop an RPM for postoperative delirium should include preoperative medication data as a potential predictor variable because of the modifiable nature of medication use and its impact on other factors commonly in models, such as cognition.</description><subject>Bone surgery</subject><subject>Clinical practice guidelines</subject><subject>Cognitive ability</subject><subject>Delirium</subject><subject>Delirium - chemically induced</subject><subject>Delirium - etiology</subject><subject>Delirium - prevention & control</subject><subject>Epidemiology</subject><subject>Fractures</subject><subject>Geriatrics/Gerontology</subject><subject>Gerontology</subject><subject>Health risk assessment</subject><subject>Health services</subject><subject>Heart surgery</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Intervention</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Models, Statistical</subject><subject>Neck</subject><subject>Older people</subject><subject>Patients</subject><subject>Pharmacology/Toxicology</subject><subject>Pharmacotherapy</subject><subject>Postoperative Complications - chemically induced</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Predictive Value of Tests</subject><subject>Prevention</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Subject heading schemes</subject><subject>Systematic Review</subject><issn>1170-229X</issn><issn>1179-1969</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1kdFKHDEUhoNYdF19gN7IgDfeTE3OTDLJVZHdagWlUhS8C8nMmRKdnWyTmULv-hq-nk_S7K52QehVAuf7vxzyE_KR0U-M0uoslhSEyCmTOeUgcrFDJoxVKmdKqN31neYA6mGfHMT4SCkVAGyP7IMqoagknZB27rPvLj5ltwEbVw_O99mNb7CLWetDduvj4JcYzOB-YTbHzgU3LrKZ76NrMM3TAPshvvx5Xhm26M3KZta6-4ifD8mH1nQRj17PKbm_-HI3-5pff7u8mp1f53VRwZALK-qWK8WNYIIxC5Zb4NjawnBZmRobYWpqsTZWVpYbaKGtFBRFI1OiMMWUnG68y-B_jhgHvXCxxq4zPfoxaqCUUVGWUiX05B366MfQp-00sFJyoSSXiWIbqg4-xoCtXga3MOG3ZlSvStCbEnQqQa9K0CJljl_No11g8y_x9usJgA0Q06j_gWH79P-tfwFUNJOy</recordid><startdate>20180301</startdate><enddate>20180301</enddate><creator>Kassie, Gizat M.</creator><creator>Nguyen, Tuan A.</creator><creator>Kalisch Ellett, Lisa M.</creator><creator>Pratt, Nicole L.</creator><creator>Roughead, Elizabeth E.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4286-3771</orcidid></search><sort><creationdate>20180301</creationdate><title>Do Risk Prediction Models for Postoperative Delirium Consider Patients’ Preoperative Medication Use?</title><author>Kassie, Gizat M. ; Nguyen, Tuan A. ; Kalisch Ellett, Lisa M. ; Pratt, Nicole L. ; Roughead, Elizabeth E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-6b6cf5995a61611b2b5b25efb3a587aced6ac0becab87b5a2f2f79233d8a613a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Bone surgery</topic><topic>Clinical practice guidelines</topic><topic>Cognitive ability</topic><topic>Delirium</topic><topic>Delirium - chemically induced</topic><topic>Delirium - etiology</topic><topic>Delirium - prevention & control</topic><topic>Epidemiology</topic><topic>Fractures</topic><topic>Geriatrics/Gerontology</topic><topic>Gerontology</topic><topic>Health risk assessment</topic><topic>Health services</topic><topic>Heart surgery</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Intervention</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Models, Statistical</topic><topic>Neck</topic><topic>Older people</topic><topic>Patients</topic><topic>Pharmacology/Toxicology</topic><topic>Pharmacotherapy</topic><topic>Postoperative Complications - chemically induced</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Predictive Value of Tests</topic><topic>Prevention</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Subject heading schemes</topic><topic>Systematic Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kassie, Gizat M.</creatorcontrib><creatorcontrib>Nguyen, Tuan A.</creatorcontrib><creatorcontrib>Kalisch Ellett, Lisa M.</creatorcontrib><creatorcontrib>Pratt, Nicole L.</creatorcontrib><creatorcontrib>Roughead, Elizabeth E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Drugs & aging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kassie, Gizat M.</au><au>Nguyen, Tuan A.</au><au>Kalisch Ellett, Lisa M.</au><au>Pratt, Nicole L.</au><au>Roughead, Elizabeth E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Do Risk Prediction Models for Postoperative Delirium Consider Patients’ Preoperative Medication Use?</atitle><jtitle>Drugs & aging</jtitle><stitle>Drugs Aging</stitle><addtitle>Drugs Aging</addtitle><date>2018-03-01</date><risdate>2018</risdate><volume>35</volume><issue>3</issue><spage>213</spage><epage>222</epage><pages>213-222</pages><issn>1170-229X</issn><eissn>1179-1969</eissn><abstract>Background
Medicines are potentially modifiable risk factors for postoperative delirium. However, the extent to which preoperative medicines are included in risk prediction models (RPMs) is unknown.
Objective
This systematic review aimed to assess the extent of inclusion of preoperative medications in RPMs for postoperative delirium.
Methods
Articles were systematically searched from MEDLINE, EMBASE and CINAHL using Medical Subject Headings (MeSH) where possible and keywords for postoperative delirium and prediction model. Studies published until May 2017 with a primary outcome of postoperative delirium that developed an RPM containing preoperative patient information were considered. Where a study had two cohorts, a derivation and a validation cohort, findings from the derivation cohort were extracted and reported.
Results
Eighteen prospective and one retrospective cohort studies were included for review. Of the 19 studies, only nine considered preoperative medication data, with medications appearing as predictor variables in five models. There was wide variability in the factors included in the final models, with the most frequent predictors being age and cognitive impairment, appearing in 13 (68%) and 11 (58%) RPMs, respectively.
Conclusion
While medications are commonly cited risk factors for delirium, they are not adequately considered when developing RPMs. Future studies aiming to develop an RPM for postoperative delirium should include preoperative medication data as a potential predictor variable because of the modifiable nature of medication use and its impact on other factors commonly in models, such as cognition.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>29423780</pmid><doi>10.1007/s40266-018-0526-6</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-4286-3771</orcidid></addata></record> |
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subjects | Bone surgery Clinical practice guidelines Cognitive ability Delirium Delirium - chemically induced Delirium - etiology Delirium - prevention & control Epidemiology Fractures Geriatrics/Gerontology Gerontology Health risk assessment Health services Heart surgery Hospitals Humans Internal Medicine Intervention Medicine Medicine & Public Health Models, Statistical Neck Older people Patients Pharmacology/Toxicology Pharmacotherapy Postoperative Complications - chemically induced Postoperative Complications - etiology Postoperative Complications - prevention & control Predictive Value of Tests Prevention Prospective Studies Retrospective Studies Risk Assessment Risk Factors Subject heading schemes Systematic Review |
title | Do Risk Prediction Models for Postoperative Delirium Consider Patients’ Preoperative Medication Use? |
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