Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis
Abstract Background Older surgical patients are at high risk of developing postoperative delirium. Non-pharmacological strategies are recommended for delirium prevention, but no pharmacological agents have compelling evidence to decrease the incidence of delirium. The purpose of this study was to as...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-10-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12877-019-1297-6 |
| _version_ | 1819009986046459904 |
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| author | Ashley M. Campbell David Rhys Axon Jennifer R. Martin Marion K. Slack Lea Mollon Jeannie K. Lee |
| author_facet | Ashley M. Campbell David Rhys Axon Jennifer R. Martin Marion K. Slack Lea Mollon Jeannie K. Lee |
| author_sort | Ashley M. Campbell |
| collection | DOAJ |
| description | Abstract Background Older surgical patients are at high risk of developing postoperative delirium. Non-pharmacological strategies are recommended for delirium prevention, but no pharmacological agents have compelling evidence to decrease the incidence of delirium. The purpose of this study was to assess whether perioperative melatonin decreases the incidence of delirium in older adults undergoing surgical procedures. Methods A systematic search using PubMed/Medline, Embase, PsycINFO, CINAHL, and references of identified articles published in English between January 1990 and October 2017 was performed. Two independent reviewers screened titles and abstracts, and then extracted data following a full-text review of included articles with consensus generation and bias assessment. Studies reporting outcomes for melatonin or ramelteon use to prevent delirium in postoperative hospitalized patients (mean age ≥ 50 years) were eligible for inclusion. Data were pooled using a fixed-effects model to generate a forest plot and obtain a summary odds ratio for the outcome of interest (delirium incidence). Cochran’s Q and I2 values were used to investigate heterogeneity. Results Of 335 records screened, 6 studies were selected for the qualitative analysis and 6 were included in the meta-analysis (n = 1155). The mean age of patients in included studies ranged from 59 to 84 years. Patients in intervention groups typically received melatonin or ramelteon at daily doses of two to eight milligrams around cardiothoracic, orthopedic, or hepatic surgeries for one to nine days, starting on the evening before or the day of surgery. The incidence of delirium ranged from 0 to 30% in the intervention groups versus 4–33% in the comparator groups, and was significantly reduced in the melatonin group, with a summary effect of the meta-analysis yielding an odds ratio of 0.63 (95% CI 0.46 to 0.87; 0.006; I2 = 72.1%). A one study removed analysis reduced overall odds ratio to 0.310 (95% CI 0.19 to 0.50), while reducing heterogeneity (Cochran’s Q = 0.798, I2 = 0.000). Conclusion Perioperative melatonin reduced the incidence of delirium in older adults in the included studies. While optimal dosing remains an unanswered question, the potential benefit of melatonin and melatonin receptor agonists may make them a reasonable option to use for delirium prevention in older adults undergoing surgical procedures. |
| first_indexed | 2024-12-21T01:05:04Z |
| format | Article |
| id | doaj.art-dd21cd3ee8834ec6a0cd7c151a52681a |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-21T01:05:04Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-dd21cd3ee8834ec6a0cd7c151a52681a2022-12-21T19:21:05ZengBMCBMC Geriatrics1471-23182019-10-0119111010.1186/s12877-019-1297-6Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysisAshley M. Campbell0David Rhys Axon1Jennifer R. Martin2Marion K. Slack3Lea Mollon4Jeannie K. Lee5College of Pharmacy, University of ArizonaCollege of Pharmacy, University of ArizonaCollege of Pharmacy, University of ArizonaCollege of Pharmacy, University of ArizonaCollege of Pharmacy, University of ArizonaCollege of Pharmacy, University of ArizonaAbstract Background Older surgical patients are at high risk of developing postoperative delirium. Non-pharmacological strategies are recommended for delirium prevention, but no pharmacological agents have compelling evidence to decrease the incidence of delirium. The purpose of this study was to assess whether perioperative melatonin decreases the incidence of delirium in older adults undergoing surgical procedures. Methods A systematic search using PubMed/Medline, Embase, PsycINFO, CINAHL, and references of identified articles published in English between January 1990 and October 2017 was performed. Two independent reviewers screened titles and abstracts, and then extracted data following a full-text review of included articles with consensus generation and bias assessment. Studies reporting outcomes for melatonin or ramelteon use to prevent delirium in postoperative hospitalized patients (mean age ≥ 50 years) were eligible for inclusion. Data were pooled using a fixed-effects model to generate a forest plot and obtain a summary odds ratio for the outcome of interest (delirium incidence). Cochran’s Q and I2 values were used to investigate heterogeneity. Results Of 335 records screened, 6 studies were selected for the qualitative analysis and 6 were included in the meta-analysis (n = 1155). The mean age of patients in included studies ranged from 59 to 84 years. Patients in intervention groups typically received melatonin or ramelteon at daily doses of two to eight milligrams around cardiothoracic, orthopedic, or hepatic surgeries for one to nine days, starting on the evening before or the day of surgery. The incidence of delirium ranged from 0 to 30% in the intervention groups versus 4–33% in the comparator groups, and was significantly reduced in the melatonin group, with a summary effect of the meta-analysis yielding an odds ratio of 0.63 (95% CI 0.46 to 0.87; 0.006; I2 = 72.1%). A one study removed analysis reduced overall odds ratio to 0.310 (95% CI 0.19 to 0.50), while reducing heterogeneity (Cochran’s Q = 0.798, I2 = 0.000). Conclusion Perioperative melatonin reduced the incidence of delirium in older adults in the included studies. While optimal dosing remains an unanswered question, the potential benefit of melatonin and melatonin receptor agonists may make them a reasonable option to use for delirium prevention in older adults undergoing surgical procedures.http://link.springer.com/article/10.1186/s12877-019-1297-6MelatoninRamelteonDeliriumPostoperativeGeriatric |
| spellingShingle | Ashley M. Campbell David Rhys Axon Jennifer R. Martin Marion K. Slack Lea Mollon Jeannie K. Lee Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis BMC Geriatrics Melatonin Ramelteon Delirium Postoperative Geriatric |
| title | Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis |
| title_full | Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis |
| title_fullStr | Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis |
| title_full_unstemmed | Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis |
| title_short | Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis |
| title_sort | melatonin for the prevention of postoperative delirium in older adults a systematic review and meta analysis |
| topic | Melatonin Ramelteon Delirium Postoperative Geriatric |
| url | http://link.springer.com/article/10.1186/s12877-019-1297-6 |
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