Perioperative medicine & outcomes
Preoperative cognitive training for preventing perioperative neurocognitive disorders: A systematic review and meta-analysis with trial sequential analysis and meta-regression of randomised controlled trials
Pooled result · Postoperative delirium (POD)Result — go to the resultRelative risk 0.53 95% CI 0.36–0.77Authors' conclusion
Preoperative cognitive training may reduce the incidence of POD, with traditional training showing a potentially greater benefit than digital training. For DNR, the current evidence is insufficient to support a preventive effect of preoperative cognitive training, although a trend toward benefit was observed. These findings are limited by high risk of bias in several included trials and failure to reach the required information sizes in TSA, particularly for DNR, which need to be confirmed in future large-scale RCTs.
Study context
- Population
- Patients undergoing surgery in RCTs comparing preoperative cognitive training with usual carepatients in thirteen RCTs
- Participants
- 1,446 patients
- Comparison
- Preoperative cognitive training, compared with usual care
- Outcome
- Postoperative delirium (POD)
Pooled result
As reported in the abstract
Relative risk
0.53
95% CI 0.36–0.77
P = 0.001
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Delayed neurocognitive recovery (DNR)Very low certainty · not supported by several sensitivity analyses | 0.66 (0.46–0.96) | P = 0.03 | |
| 0.512Relative risk (log scale) |
| Outcome | β1 (95% CI) | P value |
|---|---|---|
| POD by training format (subgroup analysis and meta-regression)Meta-regression | 1.072 (0.006–2.138) | P = 0.049 |
- Postoperative delirium (POD) by training format (subgroup analysis and meta-regression): P for interaction = 0.01
POD by training format (subgroup analysis and meta-regression)
- Potentially greater benefit for traditional training
Delayed neurocognitive recovery (DNR) subgroups: training format, total duration, surgery type
- No significant differences between subgroups
- P for interaction = 0.06, 0.37, and 0.34, respectively
DNR meta-regression: overall risk of bias as potential moderator
- Overall risk of bias was a potential moderator for DNR
- P = 0.045
Trial sequential analysis
- Cumulative Z-curves did not cross the TSA boundaries; required information sizes not reached for either outcome
- Potential for false-positive findings
Original publication
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