Prevalence and influencing factors of postoperative delirium in children undergoing low-risk surgeries: A meta-analysis.

BACKGROUND

Postoperative delirium (POD) is a serious complication in pediatric surgery that may induce prolonged hospital stays, while increasing risks of cognitive impairment and mortality. Its incidence after low-risk surgery remains incompletely characterized, despite extensive study in critically ill children, especially those following cardiac surgery. This meta-analysis systematically evaluated POD prevalence and its influencing factors in children undergoing low-risk surgeries to inform clinical prevention and management strategy development.

METHODS

This meta-analysis was conducted by retrieving studies in PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, CNKI, SinoMed, Wanfang, and VIP Database from their inception to 21 March 2025. Data processing was performed using RevMan 5.4 and Stata 15.0, with subgroup analyses, meta-regression, and sensitivity analyses.

RESULTS

This study screened 31 studies involving 13,718 pediatric patients. The overall pooled POD prevalence was 23.4% (95% CI: 0.185-0.286, P < 0.001). Furthermore, significant risk factors included age < 5 years (OR = 2.75, 95% CI: 1.85-4.08, P < 0.001), preoperative anxiety (OR = 1.16, 95% CI: 1.02-1.32, P = 0.03), postoperative pain (OR = 5.52, 95% CI: 3.15-9.67, P < 0.001), otolaryngologic surgery (OR = 2.61, 95% CI: 1.47-4.63, P < 0.001), and midazolam use (OR = 2.33, 95% CI: 1.48-3.67, P < 0.001).

CONCLUSION

POD is particularly prevalent in children following low-risk pediatric surgery.

IMPLICATIONS FOR PRACTICE: Priority should be given to early identification and suitable intervention targeting modifiable risk factors (preoperative anxiety, postoperative pain, and midazolam use), particularly in young children (<5 years) and those undergoing otolaryngologic surgeries.