The Association Between Chronic Obstructive Pulmonary Disease and Postoperative Delirium: A Systematic Review and Meta-Analysis.
Zhenlin Wang, Jinhui Xu, Yufan Xi et al.
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In 30 seconds
This systematic review and meta-analysis examined whether chronic obstructive pulmonary disease (COPD) is associated with postoperative delirium (POD) in surgical patients. It included 26 studies involving 43,051 patients, with observational studies and randomised trials eligible. In adjusted analyses, COPD was associated with higher odds of POD (pooled OR 2.08, 95% CI: 1.60-2.71, P < 0.001; I 2 = 67.2%). The association was statistically significant in non-cardiac surgery but not cardiac surgery, although the difference between these subgroups was not statistically significant. The evidence does not establish causality.
Key findings
- Adjusted analyses found higher odds of POD with COPD: pooled OR 2.08 (95% CI: 1.60-2.71, P < 0.001; I 2 = 67.2%).
- The association was statistically significant in non-cardiac surgery but not cardiac surgery; the between-subgroup difference was not significant (P for interaction = 0.139).
- Studies conducted in Asia showed a stronger association, and geographic variation was identified as a potential effect modifier.
Why it matters
POD is a serious postoperative complication, and this synthesis indicates that COPD may help identify patients with higher odds of developing it. The findings support attention to delirium risk in perioperative assessment, while the observational evidence and substantial between-study heterogeneity mean the association should not be interpreted as causal or as proof that a particular management strategy prevents POD.
What to keep in mind
The evidence was predominantly observational and heterogeneous (I 2 = 67.2%), limiting causal interpretation. Insufficient data on COPD severity prevented assessment by GOLD stage.