Delirium in neurosurgery: a systematic review and meta-analysis

P. R. Kappen*, E. Kakar, C. M.F. Dirven, M. van der Jagt, M. Klimek, R. J. Osse, A. P.J.E. Vincent

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

12 Citations (Scopus)
22 Downloads (Pure)


Delirium is a frequent occurring complication in surgical patients. Nevertheless, a scientific work-up of the clinical relevance of delirium after intracranial surgery is lacking. We conducted a systematic review (CRD42020166656) to evaluate the current diagnostic work-up, incidence, risk factors and health outcomes of delirium in this population. Five databases (Embase, Medline, Web of Science, PsycINFO, Cochrane Central) were searched from inception through March 31st, 2021. Twenty-four studies (5589 patients) were included for qualitative analysis and twenty-one studies for quantitative analysis (5083 patients). Validated delirium screening tools were used in 70% of the studies, consisting of the Confusion Assessment Method (intensive care unit) (45%), Delirium Observation Screening Scale (5%), Intensive Care Delirium Screening Checklist (10%), Neelon and Champagne Confusion Scale (5%) and Nursing Delirium Screening Scale (5%). Incidence of post-operative delirium after intracranial surgery was 19%, ranging from 12 to 26% caused by variation in clinical features and delirium assessment methods. Meta-regression for age and gender did not show a correlation with delirium. We present an overview of risk factors and health outcomes associated with the onset of delirium. Our review highlights the need of future research on delirium in neurosurgery, which should focus on optimizing diagnosis and assessing prognostic significance and management.

Original languageEnglish
Pages (from-to)329-341
Number of pages13
JournalNeurosurgical Review
Issue number1
Early online date16 Aug 2021
Publication statusPublished - Feb 2022

Bibliographical note

Funding Information:
This study was funded by the Erasmus University Medical Center. The funders of the study had no role in the study design, data collection, data analysis, manuscript preparation and publication decision.

Publisher Copyright:
© 2021, The Author(s).


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