Are treatment effects consistent with hypothesized mechanisms of action proposed for postoperative delirium interventions? Reanalysis of systematic reviews

Emily G Boxell; Yuhaniz Malik; Jeyinn Wong; Min Hyung Lee; Hannah M Berntsson; Matthew J Lee; Richard S Bourne; Iain J McCullagh; Daniel Hind; Matthew J Wilson

doi:10.2217/cer-2021-0161

Are treatment effects consistent with hypothesized mechanisms of action proposed for postoperative delirium interventions? Reanalysis of systematic reviews

Emily G Boxell, Yuhaniz Malik, Jeyinn Wong, Min Hyung Lee, Hannah M Berntsson, Matthew J Lee^*, Richard S Bourne, Iain J McCullagh, Daniel Hind, Matthew J Wilson

^*Corresponding author for this work

Applied Health Sciences

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Abstract

Aim: Postoperative delirium (POD) is associated with increased morbidity and is poorly understood. The aim of this review was to identify putative mechanisms through re-analysis of randomized trials on treatment or prevention of POD.

Materials & methods: A systematic review was performed to identify systematic reviews of treatments for POD. Constituent randomized controlled trials were identified, and interventions were grouped according to hypothesized mechanisms of action. Effects were meta-analyzed by hypothesized mechanism and timing of intervention.

Results: A total of 116 randomized controlled trials described 47 individual interventions for POD, with nine mechanisms identified. The largest effects were observed for postoperative inflammation reduction, and preoperative reinforcement of sleep–wake cycle.

Conclusion: This approach identifies treatments focused on mechanisms of action that may be front runners for future trials and interventions.

Original language	English
Pages (from-to)	1301–1315
Number of pages	15
Journal	Journal of Comparative Effectiveness Research
Volume	10
Issue number	17
DOIs	https://doi.org/10.2217/cer-2021-0161
Publication status	Published - 29 Sept 2021

Keywords

aging health
meta-analysis
methodology
surgery

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BoxellE2021treatmentFinal published version, 1.31 MBLicence: Creative Commons: Attribution (CC BY)

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Boxell, E. G., Malik, Y., Wong, J., Lee, M. H., Berntsson, H. M., Lee, M. J., Bourne, R. S., McCullagh, I. J., Hind, D., & Wilson, M. J. (2021). Are treatment effects consistent with hypothesized mechanisms of action proposed for postoperative delirium interventions? Reanalysis of systematic reviews. Journal of Comparative Effectiveness Research, 10(17), 1301–1315. https://doi.org/10.2217/cer-2021-0161

@article{df5e21f799c742fe8668f6cd1ea90bc4,

title = "Are treatment effects consistent with hypothesized mechanisms of action proposed for postoperative delirium interventions? Reanalysis of systematic reviews",

abstract = "Aim: Postoperative delirium (POD) is associated with increased morbidity and is poorly understood. The aim of this review was to identify putative mechanisms through re-analysis of randomized trials on treatment or prevention of POD. Materials & methods: A systematic review was performed to identify systematic reviews of treatments for POD. Constituent randomized controlled trials were identified, and interventions were grouped according to hypothesized mechanisms of action. Effects were meta-analyzed by hypothesized mechanism and timing of intervention. Results: A total of 116 randomized controlled trials described 47 individual interventions for POD, with nine mechanisms identified. The largest effects were observed for postoperative inflammation reduction, and preoperative reinforcement of sleep–wake cycle. Conclusion: This approach identifies treatments focused on mechanisms of action that may be front runners for future trials and interventions.",

keywords = "aging health, meta-analysis, methodology, surgery",

author = "Boxell, {Emily G} and Yuhaniz Malik and Jeyinn Wong and Lee, {Min Hyung} and Berntsson, {Hannah M} and Lee, {Matthew J} and Bourne, {Richard S} and McCullagh, {Iain J} and Daniel Hind and Wilson, {Matthew J}",

year = "2021",

month = sep,

day = "29",

doi = "10.2217/cer-2021-0161",

language = "English",

volume = "10",

pages = "1301–1315",

journal = "Journal of Comparative Effectiveness Research",

issn = "2042-6305",

publisher = "Future Medicine",

number = "17",

}

Boxell, EG, Malik, Y, Wong, J, Lee, MH, Berntsson, HM, Lee, MJ, Bourne, RS, McCullagh, IJ, Hind, D & Wilson, MJ 2021, 'Are treatment effects consistent with hypothesized mechanisms of action proposed for postoperative delirium interventions? Reanalysis of systematic reviews', Journal of Comparative Effectiveness Research, vol. 10, no. 17, pp. 1301–1315. https://doi.org/10.2217/cer-2021-0161

Are treatment effects consistent with hypothesized mechanisms of action proposed for postoperative delirium interventions? Reanalysis of systematic reviews. / Boxell, Emily G; Malik, Yuhaniz; Wong, Jeyinn et al.
In: Journal of Comparative Effectiveness Research, Vol. 10, No. 17, 29.09.2021, p. 1301–1315.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Are treatment effects consistent with hypothesized mechanisms of action proposed for postoperative delirium interventions? Reanalysis of systematic reviews

AU - Boxell, Emily G

AU - Malik, Yuhaniz

AU - Wong, Jeyinn

AU - Lee, Min Hyung

AU - Berntsson, Hannah M

AU - Lee, Matthew J

AU - Bourne, Richard S

AU - McCullagh, Iain J

AU - Hind, Daniel

AU - Wilson, Matthew J

PY - 2021/9/29

Y1 - 2021/9/29

N2 - Aim: Postoperative delirium (POD) is associated with increased morbidity and is poorly understood. The aim of this review was to identify putative mechanisms through re-analysis of randomized trials on treatment or prevention of POD. Materials & methods: A systematic review was performed to identify systematic reviews of treatments for POD. Constituent randomized controlled trials were identified, and interventions were grouped according to hypothesized mechanisms of action. Effects were meta-analyzed by hypothesized mechanism and timing of intervention. Results: A total of 116 randomized controlled trials described 47 individual interventions for POD, with nine mechanisms identified. The largest effects were observed for postoperative inflammation reduction, and preoperative reinforcement of sleep–wake cycle. Conclusion: This approach identifies treatments focused on mechanisms of action that may be front runners for future trials and interventions.

AB - Aim: Postoperative delirium (POD) is associated with increased morbidity and is poorly understood. The aim of this review was to identify putative mechanisms through re-analysis of randomized trials on treatment or prevention of POD. Materials & methods: A systematic review was performed to identify systematic reviews of treatments for POD. Constituent randomized controlled trials were identified, and interventions were grouped according to hypothesized mechanisms of action. Effects were meta-analyzed by hypothesized mechanism and timing of intervention. Results: A total of 116 randomized controlled trials described 47 individual interventions for POD, with nine mechanisms identified. The largest effects were observed for postoperative inflammation reduction, and preoperative reinforcement of sleep–wake cycle. Conclusion: This approach identifies treatments focused on mechanisms of action that may be front runners for future trials and interventions.

KW - aging health

KW - meta-analysis

KW - methodology

KW - surgery

U2 - 10.2217/cer-2021-0161

DO - 10.2217/cer-2021-0161

M3 - Article

SN - 2042-6305

VL - 10

SP - 1301

EP - 1315

JO - Journal of Comparative Effectiveness Research

JF - Journal of Comparative Effectiveness Research

IS - 17

ER -

Are treatment effects consistent with hypothesized mechanisms of action proposed for postoperative delirium interventions? Reanalysis of systematic reviews

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