Postoperative pain and neurocognitive outcomes after noncardiac surgery: a systematic review and dose-response meta-analysis.

IF 9.1 1区医学 Q1 ANESTHESIOLOGY British journal of anaesthesia Pub Date : 2024-10-10 DOI:10.1016/j.bja.2024.08.032

Maram Khaled, Denise Sabac, Matthew Fuda, Chantal Koubaesh, Joseph Gallab, Marianna Qu, Giuliana Lo Bianco, Harsha Shanthanna, James Paul, Lehana Thabane, Maura Marcucci

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Abstract

Background: Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common after noncardiac surgery. Postsurgical pain is frequent and can persist as chronic postsurgical pain (CPSP). The association between postsurgical pain and POD or POCD is biologically plausible. We conducted this systematic review to evaluate the association between acute postsurgical pain or CPSP and POD or POCD in adults undergoing noncardiac surgery.

Methods: We followed Preferred Reporting Items for Systematic Review and Meta-Analyses. We searched MEDLINE, EMBASE, Cochrane, CINAHL and PSYCHINFO up to May 2023. We included cohort, case-control, and cross-sectional studies of any language. Pairs of reviewers independently screened studies, extracted data and assessed the risk of bias using the CLARITY tool and the Joanna Briggs Institute checklist. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Where possible, we conducted random-effects meta-analyses to summarise our findings.

Results: We analysed 30 studies (>9000 participants) that assessed the association between acute postoperative pain and POD/POCD. Dose-response meta-analyses found that postoperative pain intensity was associated with occurrence of POD (adjusted relative risk [aRR]/unit of pain intensity: 1.26; 95% confidence interval [CI]: 1.17-1.35; low certainty of evidence) and risk of developing POD (aRR/unit of pain intensity: 1.18; 95% CI: 1.08-1.30; low certainty of evidence). There was very low certainty of evidence regarding the association between postoperative pain and POCD. No studies assessed the association between CPSP and POCD. Residual confounding and substantial methodological variability between studies prevented pooling data from many of the included studies and lowered certainty of evidence.

Conclusions: Dose-response meta-analyses found that postoperative pain intensity was associated with occurrence of and risk of developing POD.

Systematic review protocol: PROSPERO-CRD42021192105.

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非心脏手术后的术后疼痛和神经认知结果：系统综述和剂量反应荟萃分析。

背景：术后谵妄（POD）和术后认知功能障碍（POCD）在非心脏手术后很常见。手术后疼痛经常发生，并可持续成为慢性手术后疼痛（CPSP）。手术后疼痛与 POD 或 POCD 之间的关联在生物学上是可信的。我们进行了这项系统性综述，以评估接受非心脏手术的成人急性术后疼痛或 CPSP 与 POD 或 POCD 之间的关联：方法：我们遵循《系统综述和元分析首选报告项目》。我们检索了截至 2023 年 5 月的 MEDLINE、EMBASE、Cochrane、CINAHL 和 PSYCHINFO。我们纳入了任何语言的队列、病例对照和横断面研究。两对审稿人独立筛选研究、提取数据，并使用CLARITY工具和乔安娜-布里格斯研究所检查表评估偏倚风险。我们使用 "建议分级评估、发展和评价 "方法对证据的确定性进行了评估。在可能的情况下，我们进行了随机效应荟萃分析来总结我们的研究结果：我们分析了 30 项评估术后急性疼痛与 POD/POCD 关联性的研究（超过 9000 人参与）。剂量-反应荟萃分析发现，术后疼痛强度与 POD 的发生有关（调整后相对风险 [aRR]/ 单位疼痛强度：1.26；95% 置信区间 [CI]：1.17-1.35；低）：1.17-1.35；证据确定性低）和发生 POD 的风险（aRR/单位疼痛强度：1.18；95% 置信区间 [CI]：1.08-1.30；证据确定性低）。关于术后疼痛与 POCD 之间的关系，证据的确定性很低。没有研究评估了 CPSP 与 POCD 之间的关系。研究间残留的混杂因素和方法上的巨大差异阻碍了许多纳入研究的数据汇总，降低了证据的确定性：剂量-反应荟萃分析发现，术后疼痛强度与 POD 的发生和风险有关：PROSPERO-CRD42021192105.

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.