Author: Lahiri NK, et al.
British Journal of Anaesthesia 135(2), 2025.
This systematic review and meta-regression analyzed 187 randomized controlled trials investigating strategies to prevent postoperative neurocognitive disorder (pNCD) and delayed neurocognitive recovery (dNCR) in adult surgical patients. Trials involving pediatric patients or same-day cognitive assessments were excluded. The analysis examined trial-level factors that influenced apparent prevention effectiveness.
The findings showed that regional origin strongly influenced results: trials from the USA/Canada, Europe/Australia/New Zealand, and other regions all reported reduced effectiveness compared with those conducted in China. Higher baseline incidence of pNCD/dNCR in control groups was associated with greater observed effectiveness. Trials involving volatile anesthetics were linked to reduced effectiveness compared with dexmedetomidine or abdominal surgery cohorts. Registered trials showed enhanced effectiveness, whereas trials with formal power analyses or high risk of reporting bias demonstrated reduced effectiveness. Dexmedetomidine was the most studied agent, showing potential benefit, but overall certainty of evidence was rated very low.
Key Takeaways
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Regional differences: Non-Chinese trials showed reduced prevention effectiveness compared with Chinese studies.
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Baseline incidence: Higher control group incidence correlated with greater apparent intervention effect.
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Anesthetic type: Volatile anesthetics were associated with worse outcomes; dexmedetomidine appeared more favorable.
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Methodology: Registered trials performed better; those with power analyses or reporting bias showed reduced effectiveness.
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Certainty: Despite frequent study, evidence supporting dexmedetomidine or other interventions remains of very low certainty.
Thank you to the British Journal of Anaesthesia for publishing this important global analysis on preventing postoperative neurocognitive disorders.