title: Prophylactic antipsychotic use for postoperative delirium: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Although antipsychotics have been used empirically to prevent the development of postoperative delirium, there has been no confirming evidence to support their use. Thus, we conducted a systematic review and a meta-analysis to elucidate their efficacy and tolerability in surgical patients.
  
  
  METHODS
  MEDLINE, EMBASE, the Cochrane Library databases, CINAHL, and PsycINFO were searched up to February 2013 without language restrictions, using the following keywords: (antipsychotics OR [nonproprietary name of each antipsychotic medication, separated by OR]) AND delirium AND (randomized OR random OR randomly).
  
  
  METHODS
  Randomized controlled trials comparing prophylactic use of antipsychotics with placebo in surgical patients were included.
  
  
  METHODS
  Two authors extracted and scrutinized the data. The risk ratio (RR), 95% confidence interval (CI), number needed to treat (NNT), and standardized mean difference were used.
  
  
  RESULTS
  Six studies (3 haloperidol, 1 olanzapine, and 2 risperidone) including 1,689 surgical patients were identified. The results showed significant efficacy in reducing the occurrence of delirium (RR = 0.50, 95% CI = 0.34 to 0.73, P = .0003; NNT = 7, P = .001, 6 studies). Sensitivity analysis showed that second-generation antipsychotics were superior to placebo (RR = 0.36, P < .00001; NNT = 4, P < .00001), whereas haloperidol failed to show superiority to placebo. There were no statistically significant differences between groups in severity of delirium, discontinuation rate, or rates of several adverse events.
  
  
  CONCLUSIONS
  Our results suggest that second-generation antipsychotics are more beneficial than placebo for preventing the incidence of delirium. Among patients who do develop delirium, the severity of delirium is not reduced in those who received prophylactic antipsychotics.
authors.affiliation: Department of Psychiatry, Vanderbilt University Medical Center, 1601 23rd Ave S, 3102 VPH, Nashville, TN 37212 tomoya.hirota@vanderbilt.edu.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hirota
authors.forename: Taro
authors.initials: T
authors.lastname: Kishi
mesh_terms: D014150:Antipsychotic Agents / Q000145:classification / Q000627:therapeutic use; D018890:Chemoprevention; D057186:Comparative Effectiveness Research; D003693:Delirium / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D018579:Patient Selection; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013810:Therapeutic Equivalency
chemical_list: D014150:Antipsychotic Agents