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

This is peer-reviewed supplementary material for the article 'Are treatment effects consistent with hypothesised mechanisms of action proposed for postoperative delirium interventions? Reanalysis of systematic reviews' published in the Journal of Comparative Effectiveness Research.Summary: 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.

本为《比较疗效研究杂志》上发表的论文《术后谵妄的治疗效果是否与所提出的干预措施作用机制一致？系统评价的再分析》的同行评审补充材料。摘要：研究目的：术后谵妄（POD）与较高的发病率相关，且理解程度有限。本综述旨在通过重新分析关于POD治疗或预防的随机试验，以识别可能的机制。材料与方法：进行了一项系统评价，以识别关于POD治疗的系统评价。确定了构成随机对照试验，并将干预措施根据假定的作用机制进行分组。通过假定的作用机制和干预时机进行荟萃分析。结果：共描述了116项随机对照试验，涉及47项针对POD的个体干预措施，确定了九种机制。最大的效果出现在术后炎症减少和术前加强睡眠-觉醒周期。结论：此方法确定了针对作用机制的干预措施，这些措施可能是未来试验和干预措施的前沿。