Patterns of prevention effectiveness in postoperative neurocognitive disorder and delayed neurocognitive recovery research: a systematic review with meta-regression of randomised trials

Lahiri, NK; Vuckovic, N; Sidhu, AS; Li, J; Sun, Y; Naiken, S; Curtis, SJ; Bisch, E; Bolda, R; Nagra, PS; Mann, G; Gonzales, AE; Smith, L; Anderson, BP; Liu, Z; Adams, DC; Meng, L

doi:10.1016/j.bja.2025.04.021

Perioperative medicine & outcomes

Patterns of prevention effectiveness in postoperative neurocognitive disorder and delayed neurocognitive recovery research: a systematic review with meta-regression of randomised trials

Br J AnaesthPublished 5 Jun 2025Systematic review with meta-regression of randomised trials

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Authors' conclusion

Trial-level characteristics were significantly associated with prevention effectiveness in pNCD/dNCR research.

Study context

Population: RCTs of pNCD/dNCR prevention in adult surgical patientseligible trials analysed
Participants: 187 participants

Comparison: Trial-level characteristics associated with prevention effectiveness
Outcome: Prevention effectiveness associated with trial-level characteristics (ratio of OR)

Methodological detailsmultivariable meta-regression

Multivariable meta-regression

Pooled result

As reported in the abstract

Trial-level characteristics associated with prevention effectiveness (ratio of OR)

Ratio of OR (95% CI)P value

USA/Canada trials vs China trialsreduced effectiveness

3.04(1.62–5.73)

P = 0.001

Europe/Australia/New Zealand trials vs China trialsreduced effectiveness

1.58(1.04–2.40)

P = 0.033

Other regions trials vs China trialsreduced effectiveness

2.0(1.19–3.36)

P = 0.009

Higher pNCD/dNCR incidence in control groupsgreater effectiveness

0.98(0.97–0.99)

P < 0.001

Volatile anaesthetics trials vs Dexmedetomidine trialsreduced effectiveness

2.12(1.16–3.86)

P = 0.014

Registered trialsenhanced effectiveness

0.69(0.50–0.95)

P = 0.022

Trials with power analysesreduced effectiveness

1.43(1.06–1.94)

P = 0.021

High risk of bias in selection of reported resultreduced effectiveness

2.99(1.04–8.59)

P = 0.041

Further pooled results

Dexmedetomidine

Most studied intervention, potential benefits, very low evidence certainty

Original publication

Patterns of prevention effectiveness in postoperative neurocognitive disorder and delayed neurocognitive recovery research: a systematic review with meta-regression of randomised trials. Br J Anaesth. Published 5 June 2025. doi:10.1016/j.bja.2025.04.021

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