{ "abstract": "Background: Postoperative delirium (POD) is a fluctuating confusional state occurring early after surgery. Given its fluctuating nature, POD detection is influenced by the frequency and timing of screening. Sparse assessments potentially underestimate the true incidence reported in individual studies, subsequently influencing the weight of studies in meta-analyses, and the results and precision of these meta-analyses. Objective: To develop a method to evaluate the robustness of meta-analyses to the variation in the frequency and timing of POD assessment across included studies. Methods: We developed an expert-based scoring system to rate studies according to the confidence that a patient reported not to have POD in the study truly did not, based on the reported timing and frequency of POD assessments. We describe how to use the system to generate hypothetical event rates for studies if the frequency and timing of POD assessment were optimal and how to use these rates in a sensitivity analysis of meta-analyses including these studies. We illustrate the method applying it to two meta-analyses as work examples, one of observational studies and one of randomized controlled trials (RCTs). Results: In our work examples, the expert-based score for the individual studies ranged from 33–77% for the observational and 22–70% for RCTs meta-analysis. Sensitivity analyses showed a change in the pooled effect size, heterogeneity, and precision compared to the original estimates. Conclusion: We present a method to evaluate the robustness of a meta-analysis of studies having POD as an outcome, when there is variation across individual studies in the frequency and timing of POD assessment. The confidence score acts as a preliminary index of the robustness of meta-analyses. Through work examples, we showed that the robustness depends on the characteristics of individual studies included.", "abstract_shown": true, "affiliations": [ "Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.", "Perioperative and Surgery Research Program, Population Health Research Institute, David Braley Research Institute, Hamilton, Canada.", "Department of Anesthesia, McMaster University, Hamilton, Canada.", "Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.", "Department of Anesthesiology, Neurological Surgery, and Outcomes and Clinical Research in Perioperative Medicine, Stony Brook University, New York, United States of America.", "Departments of Anesthesiology, Critical Care, and Pain Medicine, Sapienza University of Rome, Rome, Italy.", "Department of Anesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand.", "Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administration, Hong Kong, China.", "Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.", "Department of Medicine, McMaster University, Hamilton, Canada.", "Department of Anesthesiology, Kaiser South Sacramento, California, United States of America.", "Department of Quantitative Health Sciences, Cleveland Clinic, Ohio, United States of America.", "Faculty of Medicine and Health, University of Sydney, Sydney, Australia.", "Center for Outcomes Research and Departments of Anesthesiology and Biostatistics, U T Health, Texas, United States of America.", "Center for Outcomes Research and Department of Anesthesiology, Critical Care and Pain Medicine, U T Health, Texas, United States of America.", "Department of Anesthesiology, Peking University First Hospital, Beijing, China.", "Clinic and Polyclinic for Anesthesiology and Operative Intensive Care Medicine, University of Bonn, Germany.", "Clinical Epidemiology and Research Centre (CERC), Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy." ], "article_type": "Research Article", "arxiv": null, "author_total": 21, "authors": [ { "affs": [ 0, 1 ], "name": "Maram Khaled", "orcid": "0000-0003-1200-1388" }, { "affs": [ 2, 0 ], "name": "Harsha Shanthanna" }, { "affs": [ 2, 0 ], "name": "Lehana Thabane" }, { "affs": [ 2, 0 ], "name": "James Paul" }, { "affs": [ 3 ], "name": "Anthony Absalom", "orcid": "0000-0001-7563-9157" }, { "affs": [ 4 ], "name": "Sergio Bergese" }, { "affs": [ 5 ], "name": "Federico Bilotta" }, { "affs": [ 6 ], "name": "Douglas Campbell" }, { "affs": [ 7 ], "name": "Matthew Chan", "orcid": "0000-0002-3574-7855" }, { "affs": [ 8 ], "name": "Mark Coburn" }, { "affs": [ 9 ], "name": "David Cowan" }, { "affs": [ 10 ], "name": "Kamal Maheshwari" }, { "affs": [ 11 ], "name": "Edward Mascha" }, { "affs": [ 12 ], "name": "Robert D Sanders" }, { "affs": [ 13 ], "name": "Daniel I Sessler", "orcid": "0000-0001-9932-3077" }, { "affs": [ 6 ], "name": "Tim Short" }, { "affs": [ 2, 0, 1 ], "name": "Jessica Spence" }, { "affs": [ 14 ], "name": "Alparslan Turan" }, { "affs": [ 15 ], "name": "Dong-Xin Wang", "orcid": "0000-0002-3205-1836" }, { "affs": [ 16 ], "name": "Maria Wittmann" }, { "affs": [ 17, 0, 1 ], "name": "Maura Marcucci", "orcid": "0000-0002-8468-7991" } ], "bibtex": "https://research.draconitic.com/paper/7k99e47qrxs9f.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0361124", "fulltext_url": "https://europepmc.org/articles/PMC13690229", "id": "7k99e47qrxs9f", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0361124", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "1804|Meta-analysis and systematic reviews" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Clinical trials/Randomized controlled trials" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Pain" ], [ "plos", "/Medicine and health sciences/Epidemiology" ], [ "plos", "/Medicine and health sciences/Pharmacology/Drug research and development/Clinical trials/Randomized controlled trials" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures" ], [ "plos", "/Physical sciences/Mathematics/Statistics/Statistical methods/Metaanalysis" ], [ "plos", "/Research and analysis methods/Clinical trials/Randomized controlled trials" ], [ "plos", "/Research and analysis methods/Mathematical and statistical techniques/Statistical methods/Metaanalysis" ], [ "plos", "/Research and analysis methods/Research assessment/Systematic reviews" ], [ "plos", "/Research and analysis methods/Research design/Observational studies" ], [ "plos", "/Research and analysis methods/Research design/Survey research/Questionnaires" ] ], "openalex": "W7223218992", "pdf_url": "https://europepmc.org/articles/PMC13690229?pdf=render", "pmcid": "PMC13690229", "pmid": "42911914", "published": "2026-10-22", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/7k99e47qrxs9f.ris", "sources": [ { "first_seen": "2026-10-30T12:17:23Z", "native_id": "10.1371/journal.pone.0361124", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0361124" }, { "first_seen": "2026-10-30T12:20:10Z", "native_id": "MED:42911914", "source": "europepmc", "url": "https://europepmc.org/article/MED/42911914" } ], "subjects": [ { "field": "mathematics", "origin": "plos:statistical methods", "subfield": "statistics" }, { "field": "medicine", "origin": "plos:clinical trials", "subfield": "clinical-trials" } ], "title": "Assessing the robustness of meta-analyses to variability in the frequency and timing of postoperative delirium assessment – a novel methodological approach", "title_text": "Assessing the robustness of meta-analyses to variability in the frequency and timing of postoperative delirium assessment – a novel methodological approach", "type": "peer-reviewed", "updated_at": "2026-10-30T12:20:10Z", "url": "https://research.draconitic.com/paper/7k99e47qrxs9f", "venue": "PLOS One", "versions": [] }