Association between sarcopenia and postoperative delirium in elderly surgical patients: a systematic review and meta-analysis

BMC Geriatr. 2025 Jul 12;25(1):520. doi: 10.1186/s12877-025-06183-2.

Abstract

Background: Sarcopenia, characterized by the progressive loss of muscle mass and strength, is common in the elderly and significantly increases the risk of poor postoperative outcomes. This study aims to examine the impact of sarcopenia on postoperative delirium and a range of perioperative outcomes in elderly patients.

Methods: A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL. Studies investigating the association between sarcopenia and postoperative complications in elderly surgical patients were included. The Quality in Prognosis Studies (QUIPS) tool was utilized for risk-of-bias assessment. The primary outcome was the incidence of postoperative delirium. Secondary outcomes included other postoperative complications and further recovery. Subgroup analyses were conducted based on surgery types.

Results: A total of 10,981 records were identified, with 265 studies included in the systematic review and 242 in the final meta-analysis. A significant association was found between sarcopenia and postoperative delirium in both univariable and multivariable analyses (univariable: OR 1.81, 95% confidence interval [CI] 1.31 to 2.50, P < 0.001, I2 24.0%; multivariable: OR 2.42, 95% CI 1.27 to 4.59, P = 0.007, I2 0.0%). Sarcopenia was also associated with adverse postoperative outcomes, including increased complications, mortality, delayed recovery, and reduced overall survival. However, no significant associations were observed for postoperative pancreatic fistula or recurrence. Syntheses of multivariable analyses showed significant differences in postoperative complications, mortality, overall survival, and recurrence. Subgroup analyses indicated a higher risk of reduced overall survival among sarcopenic patients undergoing head and neck or heart and chest surgeries.

Conclusions: Sarcopenia is a strong independent predictor of postoperative delirium and poor postoperative outcomes in elderly surgical patients.

Systematic review registration: PROSPERO registration number CRD42023424696 (18 May 2023).

Keywords: Evidence synthesis; Postoperative complications; Postoperative delirium; Sarcopenia; Surgery.

Publication types

  • Systematic Review
  • Meta-Analysis

MeSH terms

  • Aged
  • Delirium* / diagnosis
  • Delirium* / epidemiology
  • Delirium* / etiology
  • Humans
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Sarcopenia* / complications
  • Sarcopenia* / diagnosis
  • Sarcopenia* / epidemiology