Preventative interventions for postoperative delirium after intraabdominal surgery - A systematic review and meta-analysis of randomized trials

Background: Postoperative delirium (POD) is a significant complication associated with extended hospital stays, increased healthcare costs, and heightened morbidity and mortality. With an aging population, the incidence of POD is expected to rise, making the development of effective prevention strategies critical. This study aimed to evaluate the effectiveness of preventive interventions in reducing POD after intraabdominal surgery. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases including MEDLINE, Embase, and The Cochrane Library were searched for randomized controlled trials (RCTs) that examined preventive strategies for POD in adult patients undergoing intraabdominal surgery. The primary outcome was the incidence of POD, analyzed using a random-effects meta-analysis. Results: Sixteen RCTs involving 4060 participants were included. Preventive interventions reduced the risk of POD by 49 % (RR: 0.51; 95 % CI: 0.36 to 0.73; I2 1/4 61.2 %). No significant effects were observed on secondary outcomes such as 30-day and 180-day mortality or length of hospital stay. Subgroup analyses showed a more pronounced effect in laparoscopic surgeries and smaller trials with higher risk of bias. Conclusions: Preventive interventions are effective in reducing the incidence of POD after intraabdominal surgery. These findings highlight the importance of incorporating standardized screening and intervention protocols to improve surgical outcomes, especially in high-risk populations. Further research should focus on refining prevention strategies and exploring the underlying mechanisms of POD.