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. 2022 Mar 28:9:844371.
doi: 10.3389/fmed.2022.844371. eCollection 2022.

The Effect of General Anesthesia vs. Regional Anesthesia on Postoperative Delirium-A Systematic Review and Meta-Analysis

Xianlin Zhu  1 , Min Yang  1 , Junying Mu  1 , Zaiping Wang  1 , Liang Zhang  2 , Hongbai Wang  3 , Fuxia Yan  3
Affiliations

The Effect of General Anesthesia vs. Regional Anesthesia on Postoperative Delirium-A Systematic Review and Meta-Analysis

Xianlin Zhu et al. Front Med (Lausanne). .

Abstract

Background: Postoperative delirium (POD) commonly occurs in patients following major surgeries and is associated with adverse prognosis. The modes of anesthesia may be associated with POD occurrence. General anesthesia (GA) causes loss of consciousness in the patient by altering the levels of some neurotransmitters as well as signaling pathways. We conducted this meta-analysis to investigate the effect of GA vs. regional anesthesia (RA) on POD incidence in surgical patients.

Methods: The databases of Pubmed, Embase, and Cochrane Library were searched till October 22, 2021. The eligible criteria were participants aged 18 years or older, patients undergoing surgery under GA and RA, and articles reporting the effect of GA vs. RA on POD incidence. RevMan 5.3 was used to perform statistical analyses.

Results: A total of 21 relevant trials with a total of 1,702,151 patients were included. The pooled result using random-effects model with OR demonstrated significant difference in POD incidence between patients with GA and RA (OR = 1.15, 95% CI: [1.02, 1.31], I 2 = 83%, p for effect = 0.02). We did not obtain the consistent pooled result after sensitivity analysis (OR = 0.95, 95% CI: [0.83, 1.08], I 2 =13%, p for effect = 0.44) and excluded the articles without the information on preoperative cognitive or neuropsychological assessment (OR = 1.12, 95% CI: [1.00, 1.25], I 2 =80%, p for effect = 0.05), respectively.

Conclusion: This meta-analysis could not identify that GA was significantly associated with POD occurrence in surgical patients compared with RA.

Keywords: general anesthesia; meta-analysis; neuraxial anesthesia; peripheral nerve block; postoperative delirium; regional anesthesia.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The screening process of the eligible trials.
Figure 2
Figure 2
The pooled results of POD incidence after surgery between the patients with GA and RA.
Figure 3
Figure 3
The funnel plots of all included trials: the considerable heterogeneity of included trials (A) and lowering heterogeneity through six trials exclusion (B).
Figure 4
Figure 4
The pooled result of POD incidence in surgical patients with GA and RA after sensitivity analysis.
Figure 5
Figure 5
The pooled result of POD incidence in surgical patients with GA and RA after excluding the studies without the information on preoperative cognitive or neuropsychological assessment.
Figure 6
Figure 6
The subgroup analysis according to study designs (retrospective and prospective).
Figure 7
Figure 7
The subgroup analysis according to the male percentage (≥50 and <50%).
Figure 8
Figure 8
The subgroup analysis according to mean (or median) age gaps (≥80 years, 70–80 years, 60–70 years, and <60 years).
Figure 9
Figure 9
The subgroup analysis according to anesthesia methods in the RA group (neuraxial anesthesia and PNB).
See this image and copyright information in PMC

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