Perioperative medicine & outcomes
Melatonin or ramelteon for the prevention of postoperative delirium in elderly patients: A systematic review and meta-analysis of randomized clinical trials
Pooled result · PODResult — go to the resultRelative risk 0.72 95% CI 0.56–0.92Authors' conclusion
Perioperative melatonin was associated with reduced POD in elderly surgical patients, with an apparent dose-response at ≥5 mg. Ramelteon did not demonstrate benefit in the available trials.
Study context
- Population
- Elderly patients (>60 years) undergoing surgery
- Participants
- 2,115 patients · 16 randomized controlled trials (RCTs)
- Comparison
- Melatonergic agents vs Control
- Outcome
- POD incidence
Methodological detailsrandom-effects model
- Random-effects model
Pooled result
POD
Relative risk
0.72
95% CI 0.56–0.92
P = 0.009
Events by group
Melatonergic agents vs Control
RR 0.72 (95% CI 0.56–0.92); P = 0.009
As reported in the abstract
Further pooled results
| Outcome | Control | RR (95% CI) | P value | |
|---|---|---|---|---|
| POD, melatonin-only trials (subgroup)Melatonin vs Control | 31.4% | 0.67 (0.52–0.88) | P = 0.004 | |
| POD, ramelteon trials (subgroup)Ramelteon vs Control | 14.9% | 0.98 (0.47–2.01) | P = 0.948 | |
| POD, melatonin doses ≥5 mg (subgroup)Melatonin vs Control | 36.7% | 0.52 (0.40–0.68) | P < 0.001 | |
| 0.512Relative risk (log scale) |
- Postoperative delirium (POD), melatonin-only trials (subgroup): Melatonin 22.4%
- POD, ramelteon trials (subgroup): Ramelteon 15.1%
- POD, melatonin doses ≥5 mg (subgroup): Melatonin 18.2%
Pain, Ramsay Sedation Score, LOS
- No significant differences
Original publication
Melatonin or ramelteon for the prevention of postoperative delirium in elderly patients: A systematic review and meta-analysis of randomized clinical trials. J Clin Anesth. Published 16 February 2026. doi:10.
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