Effectiveness of non-pharmacological interventions in preventing postoperative delirium in patients with oral cancer: a systematic review

doi:10.19438/j.cjoms.2024.03.013

Abstract

Abstract: PURPOSE: To evaluate the effect of non-pharmacological interventions in preventing postoperative delirium in patients with oral cancer, summarize the main components of non-pharmacological interventions in patients with oral cancer, and aid clinical decision-making. METHODS: The literatures on the prevention of postoperative delirium by non-pharmacological interventions in patients with oral cancer were searched in 8 Chinese and English electronic databases(Embase, PubMed, Web of Science, The Cochrane Library, CNKI, Wanfang database, VIP, China Biomedical Literature Service System). The search was conducted from inception to October 2023. The primary outcomes were the incidence and duration of postoperative delirium. Cochrane risk of bias assessment tool was used to evaluate the randomized controlled trials. Review manager 5.3 was used for meta-analysis. Heterogeneity was examined by sensitivity analysis, and subgroup analysis was performed. RESULTS: Five randomized controlled trials with 849 participants were included. The main components of multicomponent non-pharmacological interventions included enhancement of relevant training for healthcare professionals, intensive preoperative education and familiarity with ICU environment, postoperative sleep management, pain management, music therapy, cognitive stimulation, and full participation of family members. Meta-analysis showed that non-pharmacologic intervention reduced the overall incidence of postoperative delirium in oral cancer patients[RR=0.41, 95%CI:(0.31,0.54), I²=0%], decreased the duration of postoperative delirium [MD=-38.51, 95%CI:(-46.25,-30.77),I²=88%]. Subgroup analysis showed that non-pharmacologic intervention reduced the incidence of delirium on the first postoperative day[RR=0.37, 95%CI:(0.20,0.70), I²=0%], but had non-significant improvement in the incidence of delirium on the second and third postoperative day. Non-pharmacological interventions improved assessment of postoperative agitated sedation and quality of recovery. CONCLUSIONS: The current evidence shows that non-pharmacological interventions can reduce the overall incidence and duration of postoperative delirium, and improve agitated sedation and quality of recovery in oral cancer patients.

Key words: Non-pharmacological intervention, Prevention, Postoperative delirium, Oral cancer, Systematic review

CLC Number:

R739.8

WANG Shuai, HE Xing-fang, WANG Yun-jie, WU Wei-qin, HUANG Qiu-yu. Effectiveness of non-pharmacological interventions in preventing postoperative delirium in patients with oral cancer: a systematic review[J]. China Journal of Oral and Maxillofacial Surgery, 2024, 22(3): 279-286.

References

[1] Sung H, Ferlay J, Siegel RL, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2] Chi AC, Day TA, Neville BW.Oral cavity and oropharyngeal squamous cell carcinoma-an update[J]. CA Cancer J Clin, 2015, 65(5): 401-421.
[3] 罗爱林, 张杰. 2017版欧洲麻醉学会《基于循证和专家共识的术后谵妄指南》解读[J]. 临床外科杂志, 2018, 26(1): 29-33.
Luo AL, Zhang J.Interpretation of European Society of Anesthesiology evidence based and consensus based guideline on postoperative delirium(2017 Edition)[J]. J Clin Surg, 2018, 26(1): 29-33.
[4] 余晓宁, 蔡洁琛, 黄利浩, 等. 口腔颌面部手术术后谵妄危险因素的meta分析[J]. 中华口腔医学研究杂志(电子版), 2019, 13(3): 166-173.
Yu XN, Cai JC, Huang LH, et al.Risk factors for postoperative delirium after oral and maxillofacial surgery: a meta-analysis[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2019, 13(3): 166-173.
[5] Witlox J, Eurelings LSM, de Jonghe JFM, et al. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis[J]. JAMA, 2010, 304(4): 443-451.
[6] Makiguchi T, Yamaguchi T, Nakamura H, et al.Impact of skeletal muscle mass on postoperative delirium in patients undergoing free flap repair after oral cancer resection[J]. J Plast Surg Hand Surg, 2020, 54(3): 161-166.
[7] 刘桂英, 王阳阳, 徐克珮, 等. 成人患者谵妄管理指南的质量评价[J]. 中国循证医学杂志, 2020, 20(7): 837-844.
Liu GY, Wang YY, Xu KP, et al.Quality assessment of the guidelines for the management of delirium in adult patients[J]. Chinese Journal of Evidence-Based Medicine, 2020, 20(7): 837-844.
[8] Oh ES, Fong TG, Hshieh TT, et al.Delirium in older persons: advances in diagnosis and treatment[J]. JAMA, 2017, 318(12): 1161-1174.
[9] 中国老年医学学会麻醉学分会. 中国老年患者术后谵妄防治专家共识[J]. 国际麻醉学与复苏杂志, 2023, 44(1): 1-27.
Anesthesiology Branch of Chinese Geriatrics Society. Expert consensus on prevention and treatment of postoperative delirium in elderly patients in China[J]. International Journal of Anesthesiology and Resuscitation, 2023, 44(1): 1-27.
[10] 陈红, 汪慧娟, 陈瑜. 术后谵妄病人非药物管理最佳证据综合[J]. 护理研究, 2019, 33(23): 4108-4112.
Chen H, Wang HJ, Chen Y.Synthesis of best evidences on non-pharmacological management in patients with postoperative delirium[J]. Chinese Nursing Research, 2019, 33(23): 4108-4112.
[11] 汤铂, 王小亭, 陈文劲, 等. 重症患者谵妄管理专家共识[J]. 中华内科杂志, 2019, 58(2): 108-118.
Tang P, Wang XT, Chen WJ, et al.Experts consensus on the management of delirium in critically ill patients[J]. Chinese Journal of Internal Medicine, 2019, 58(2): 108-118.
[12] Bannon L, McGaughey J, Verghis R, et al. The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis[J]. Intensive Care Med, 2019, 45(1): 1-12.
[13] Lee Y, Lee J, Kim J, et al.Non-pharmacological nursing interventions for prevention and treatment of delirium in hospitalized adult patients: systematic review of randomized controlled trials[J]. Int J Environ Res Public Health, 2021, 18(16): 8853-8868.
[14] Lange S, Medrzycka-Dabrowska W, Friganovic A, et al.Non-pharmacological nursing interventions to prevent delirium in icu patients-an umbrella review with implications for evidence-based practice[J]. J Pers Med, 2022, 12(5): 760-780.
[15] Burry LD, Cheng W, Williamson DR, et al.Pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a systematic review and network meta-analysis[J]. Intensive Care Med, 2021, 47(9): 943-960.
[16] 吴美, 程云, 周红艳, 等. 老年患者术后谵妄非药物预防措施的证据总结[J]. 护理学杂志, 2019, 34(7): 76-79.
Wu M, Cheng Y, Zhou HY, et al.Evidence synthesis for nonpharmacological prevention of postoperative delirium in elderly patients[J]. Journal of Nursing Science, 2019, 34(7): 76-79.
[17] Higgins J, Green S.CochraneHandbook for Systematic Reviews of Interventions[EB/OL].[2023-07-17].https://training.cochrane.org/zh-hans/cochrane-%E5%B9%B2%E9%A2%84%E6%8E%AA%E6%96%BD%E7%B3%BB%E7%BB%9F%E8%AF%84%E4%BB%B7%E6%89%8B%E5%86%8C-%E4%B8%AD%E6%96%87%E7%BF%BB%E8%AF%91%E7%89%88.
[18] PRISMA Checklist[EB/OL].PRISMA Checklist[EB/OL].[2023-07-17]. https://www.prisma-statement.org/prisma-2020.
[19] Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews[J]. PLoS Med, 2021, 18(3): e1003583.
[20] Guo Y, Sun L, Li L, et al.Impact of multicomponent, nonpharmacologic interventions on perioperative cortisol and melatonin levels and postoperative delirium in elderly oral cancer patients[J]. Arch Gerontol Geriatr, 2016, 62(1): 112-117.
[21] 毛艳, 徐瑾, 侯贺惠, 等. 病房与ICU护士联合术前访视预防颌面部恶性肿瘤患者术后ICU谵妄研究[J]. 护理学杂志, 2018, 33(11): 23-25.
Mao Y, Xu J, Hou HH, et al.Prevention of postoperative delirium during an ICU stay following maxillofacial tumor surgery through collaborative preoperative visit by ward and ICU nurses[J]. Journal of Nursing Science, 2018, 33(11): 23-25.
[22] 陈艳双, 牟兰兰, 王庆梅. 集束化护理和常规护理对老年口腔癌患者术后谵妄的影响[J]. 医学美学美容, 2019, 28(20): 91-91.
Chen YS, Mou LL, Wang QM.Effect of cluster nursing and routine nursing on postoperative delirium in elderly patients with oral cancer[J]. Journal of Medical Aesthetics and Cosmetology, 2019, 28(20): 91-91.
[23] 刘涵, 徐小川, 张育红, 等. 集束化护理对口腔癌患者术后谵妄的影响分析[J]. 中国肿瘤临床与康复, 2019, 26(1): 97-100.
Liu H, Xu XC, Zhang YH, et al.Effect of clustering care on postoperative delirium in patients with oral cancer[J]. Chinese Journal of Clinical Oncology and Rehabilitation, 2019, 26(1): 97-100.
[24] 郑莉莉, 徐继文, 闫华. 系统化护理干预对降低口腔癌皮瓣移植患者术后谵妄的效果分析[J]. 中文科技期刊数据库(全文版)医药卫生, 2021(8): 86-87.
Zheng LL, Xu JW, Yan H.Analysis of the effect of systematic nursing intervention on reducing postoperative delirium in patients with oral cancer flap transplantation[J]. Chinese Science and Technology Journal Database( Full-text Edition ) Medical and Health, 2021(8): 86-87.
[25] Matsuura Y, Ohno Y, Toyoshima M, et al.Effects of non-pharmacologic prevention on delirium in critically ill patients: a network meta-analysis[J]. Nurs Crit Care, 2023, 28(5): 727-737.
[26] Jin Z, Hu J, Ma D.Postoperative delirium: perioperative assessment, risk reduction, and management[J]. Br J Anaesth, 2020, 125(4): 492-504.
[27] Taxis J, Spoerl S, Broszio A, et al.Postoperative delirium after reconstructive surgery in the head and neck region[J]. J Clin Med, 2022, 11(22): 6630-6639.
[28] Ghezzi ES, Greaves D, Boord MS, et al. How do predisposing factors differ between delirium motor subtypes? a systematic review and meta-analysis[J]. Age Ageing, 2022, 51(9): afac200.
[29] American Psychiatric Association.Diagnostic and statistical manual of mental disorders[M]. Fifth Ed. Washington: American Psychiatric Association, 2013.
[30] Numan T, van den Boogaard M, Kamper AM, et al. Delirium detection using relative delta power based on 1-minute single-channel EEG: a multicentre study[J]. Br J Anaesth, 2019, 122(1): 60-68.
[31] Tonna JE, Dalton A, Presson AP, et al.The Effect of a quality improvement intervention on sleep and delirium in critically ill patients in a surgical ICU[J]. Chest, 2021, 160(3): 899-908.
[32] Kiliç G, Kav S.Effect of using eye masks and earplugs in preventing delirium in intensive care patients: a single-blinded, randomized, controlled trial[J]. Nurs Crit Care, 2023, 28(5): 698-708.
[33] Kappen PR, Mos MI, Jeekel J, et al.Music to prevent delirium during neurosurgery (MUSYC): a single-center, prospective randomized controlled trial[J]. BMJ Open, 2023, 13(6): e069957.
[34] Pattison N, O’Gara G, Thomas K, et al. An aromatherapy massage intervention on sleep in the ICU : a randomized controlled feasibility study[J]. Nurs Crit Care, 2023, 29(1):14-21.
[35] 向富萍, 侯黎莉, 杨玲, 等. 头颈部肿瘤患者术后发生谵妄危险因素的meta分析[J]. 中国口腔颌面外科杂志, 2023, 21(4): 407-412.
Xiang FP, Hou LL, Yang L, et al.Meta analysis of risk factors for postoperative delirium in patients with head and neck tumours[J]. China Journal of Oral and Maxillofacial Surgery, 2023, 21(4): 407-412.
[36] 刘苗, 罗健, 黄海燕, 等. 非药物干预预防ICU获得性谵妄相关系统评价的再评价[J]. 护理学杂志, 2020, 35(1): 77-82.
Liu M, Luo J, Huang HY, et al.Overviews of systematic reviews of nonpharmacological interventions for ICU acquired delirium[J]. Journal of Nursing Science, 2020, 35(1): 77-82.
[37] 朱明明, 刘芳, 王冉. 躁动镇静评分在重症患者中应用的研究进展[J]. 中华护理杂志, 2018, 53(2): 247-250.
Zhu MM, Liu F, Wang R.Research status of the application of RASS in the evaluation of sedation effects in critical patients[J]. Chinese Journal of Nursing, 2018, 53(2): 247-250.
[38] Ahn YH, Lee HY, Lee SM, et al.Factors influencing sleep quality in the intensive care unit: a descriptive pilot study[J]. Acute Crit Care, 2023, 38(3): 278-285.
[39] Hughes CG, Boncyk CS, Culley DJ, et al.American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention[J]. Anesth Analg, 2020, 130(6): 1572-1590.