Risk factors for 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; age; complications; malnutrition; body mass index; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202411060

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Objective To systematically evaluate the risk factors for postoperative delirium (POD) in patients undergoing pneumonectomy. Methods PubMed, Web of Science, 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 pneumonectomy. 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 NOS 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], American Society of Anesthesiologists (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] were all risk factors for POD, while high body mass index (BMI) [OR=0.96, 95%CI (0.95, 0.97), P<0.01] was 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.

Citation： YE Lei, WU Guanghong, DING Jiefang, WANG Qin, XIA Guanghui. Risk factors for postoperative delirium after pneumonectomy: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(4): 624-630. doi: 10.7507/1007-4848.202411060 Copy

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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.
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5.	中國老年醫學學會麻醉學分會. 中國老年患者術后譫妄防治專家共識. 國際麻醉學與復蘇雜志, 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.
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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.
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11.	尚明煦, 魏麗娟, 是若春. 血清甲狀腺激素、NLR及CRP/ALB與肺癌術后譫妄的關系. 分子診斷與治療雜志, 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.	劉微, 關丹丹, 張洪巖. 老年肺癌患者胸腔鏡下根治切除術后譫妄發生的列線圖模型的建立與評價. 現代腫瘤醫學, 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, 黎仕煥, 謝爽. 老年患者肺癌根治術后譫妄的危險因素及列線圖預測模型的建立. 臨床麻醉學雜志, 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.	鄭紅, 陳曉霞, 韓李周, 等. 老年肺葉切除術前血漿MMP-9、C1q及脂聯素變化與術后譫妄的相關性. 錦州醫科大學學報, 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.	許海陽, 劉紅, 應笑麗, 等. 肺癌患者根治術后譫妄的危險因素分析. 中國現代醫生, 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.	陳士歡. 老年患者行胸腔鏡下肺癌根治術后譫妄危險因素研究. 河北北方學院, 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.	劉靜, 雷佩, 王娟, 等. 衰弱對老年肺癌患者術后譫妄、吸入性肺炎和短期預后的預測價值. 老年醫學與保健, 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. 中國老年醫學學會麻醉學分會. 中國老年患者術后譫妄防治專家共識. 國際麻醉學與復蘇雜志, 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. 陳軍, 車國衛, 孫大強, 等. 老年肺癌外科治療中國專家共識 (2022版). 中國肺癌雜志, 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. 譚文斐, 郭冰, 金鳳, 等. 肺葉切除術患者術后譫妄的危險因素分析. 臨床麻醉學雜志, 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, 魏麗娟, 是若春. 血清甲狀腺激素、NLR及CRP/ALB與肺癌術后譫妄的關系. 分子診斷與治療雜志, 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. 劉微, 關丹丹, 張洪巖. 老年肺癌患者胸腔鏡下根治切除術后譫妄發生的列線圖模型的建立與評價. 現代腫瘤醫學, 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, 黎仕煥, 謝爽. 老年患者肺癌根治術后譫妄的危險因素及列線圖預測模型的建立. 臨床麻醉學雜志, 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. 鄭紅, 陳曉霞, 韓李周, 等. 老年肺葉切除術前血漿MMP-9、C1q及脂聯素變化與術后譫妄的相關性. 錦州醫科大學學報, 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. 許海陽, 劉紅, 應笑麗, 等. 肺癌患者根治術后譫妄的危險因素分析. 中國現代醫生, 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. 陳士歡. 老年患者行胸腔鏡下肺癌根治術后譫妄危險因素研究. 河北北方學院, 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. 劉靜, 雷佩, 王娟, 等. 衰弱對老年肺癌患者術后譫妄、吸入性肺炎和短期預后的預測價值. 老年醫學與保健, 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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for postoperative delirium after pneumonectomy: A systematic review and meta-analysis

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