2024 FSA Podium and Poster Abstracts
S004: THE ROLE OF OPIOID ANALGESICS IN THE DEVELOPMENT OF POSTOPERATIVE DELIRIUM: A SYSTEMATIC REVIEW & META-ANALYSIS
Will S Roberts1; Brendan P Chernicki1; Justin Reidy1; William Delladio1; Jean-Pierre P Ouanes, DO2; Tsun Yee Law, MD, MBA3; 1Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine; 2Hospital for Special Surgery - Florida, Weill Cornell Medicine - Department of Anesthesiology; 3Hospital for Special Surgery - Florida
Introduction/Background: Postoperative delirium (POD) is among the most common of the risks associated with undergoing surgery and anesthesia. There is ongoing debate in the literature on the impact opioid analgesics play in the development of POD. It is estimated that the burden of POD on the healthcare system exceeds 30 billion dollars annually. Due to the prevalence of this adverse outcome and the burden it places on patients and the healthcare system alike, research into modifiable risk factors for its appearance could help guide clinicians in the minimization of its occurrence.
Methods: A database search containing keywords assessing opioids and POD was performed in Embase, Web of Science, and MEDLINE - PubMed. Retrieved studies were screened via Rayyan and adjusted odds ratios for associations between opioid analgesia and POD were extracted, with two-sided p-values < 0.05 being deemed significant.
Results: A total of 7,700 patients were analyzed of which 1,703 developed POD, indicating an incidence of 22.1%. Random effects meta-analysis based on 95% confidence intervals reveals that opioid use (OR 1.15, 1.09 - 1.22, p< 0.001), specifically with meperidine (OR 3.36, 1.36 - 8.32, p <0.009) or morphine (OR 1.37, 1.11 - 1.69, p<0.003), is associated with increased incidence of POD. Further, both perioperative (OR 1.10, 1.04 - 1.16, p< 0.001) and postoperative opioid administration (OR 1.92, 1.25 - 2.95, p < 0.003) were also associated.
Discussion/Conclusion: Opioid analgesics were associated with higher incidences of POD. Not all opioids increased the incidence of delirium. Elderly and renally impaired patient populations were at higher risk for developing opioid-related POD. Careful selection and judicious utilization of opioid analgesics may reduce the incidence of POD and ultimately the burden on the healthcare system.