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Meta-Analysis
. 2022 Dec 16;101(50):e32329.
doi: 10.1097/MD.0000000000032329.

Transcutaneous electrical acupoint stimulation for the prevention of perioperative neurocognitive disorders in geriatric patients: A systematic review and meta-analysis of randomized controlled trials

Shuying Li  1   2 , Hailun Jiang  1   2 , Wei Liu  1   2 , Yu Yin  1   2 , Chunsheng Yin  1   2 , Hao Chen  1   2 , Yuzheng Du  1   2 , Qi Zhao  1   2 , Yi Zhang  1   2 , Chen Li  1   2
Affiliations
Meta-Analysis

Transcutaneous electrical acupoint stimulation for the prevention of perioperative neurocognitive disorders in geriatric patients: A systematic review and meta-analysis of randomized controlled trials

Shuying Li et al. Medicine (Baltimore). .

Abstract

Background: To evaluate whether transcutaneous electrical acupoint stimulation (TEAS) decreases rates of perioperative neurocognitive disorders (PND) when used as an adjuvant method during perioperative period in geriatric patients since the new definition was released in 2018.

Methods: Six databases [Chinese National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, WanFang Database, PubMed, EMBASE, and Cochrane Library] were systematically searched. Data analysis was performed using RevMan 5.4.1 software (Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration, 2020). Risk ratios (RR) with 95% confidence interval were calculated using a random effects model. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results: 13 randomized clinical trials (999 patients) in total were included. TEAS had positive effects on preventing the incidence of PND (RR: 0.43; 0.31, 0.61; P < .001; low certainty) [postoperative delirium within 7 days (RR: 0.39; 0.26, 0.59; P < .001), delayed neurocognitive recovery within 3 months (RR: 0.51; 0.33, 0.78; P = .002)]. TEAS could also improve the scores of the confusion assessment method (CAM) (Mean difference: -1.30; -2.14, -0.46; P = .003; low certainty). Limited evidence suggested that TEAS could reduce the serum levels of biochemical indicator (S100β) (SMD = -1.08, -1.67, -0.49, P < .001; I2 = 83%; very low certainty) as well as anesthetic requirements (remifentanil) (SMD: -1.58; -2.54, -0.63; P = .001; I2 = 87%; very low certainty). Subgroup analysis indicated that different protocols of TEAS had significant pooled benefits (TEAS used only in surgery and in combination with postoperative intervention) (RR: 0.45; 0.31, 0.63; P < .001). Acupoint combination (LI4 and PC6) in the TEAS group had more significantly advantages (RR: 0.34; 0.17, 0.67; P = .002). TEAS group had a lower incidence of PND in different surgery type (orthopedic surgery and abdominal surgery) (RR: 0.43; 0.30, 0.60; P < .001), as well as with different anesthetic modality (intravenous anesthesia and intravenous and inhalational combined anesthesia) (RR: 0.38; 0.23, 0.61; P < .001).

Conclusion: In terms of clinical effectiveness, TEAS appeared to be beneficial for prophylaxis of PND during a relatively recent period, noting the limitations of the current evidence.

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Conflict of interest statement

Authors declare that there are no conflicts of interest regarding the publication of this paper. Statement of human and animal rights: This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Figure 1.
Figure 1.
Flow diagram of the study identification and selection process.
Figure 2.
Figure 2.
Assessment of ROB using the Cochrane tool. (A) ROB graph and (B) ROB summary. ROB = risk of bias.
Figure 3.
Figure 3.
Meta-analysis and forest plot for the incidence of PND. PND = perioperative neurocognitive disorders.
Figure 4.
Figure 4.
Meta-analysis and forest plot for the incidence of the different subtypes of the PND. (A) POD and (B) DNR. DNR = delayed neurocognitive recovery, PND = perioperative neurocognitive disorders.
Figure 5.
Figure 5.
Meta-analysis and forest plot for cognitive function scores. (A) CAM within 7 days. (B) MMSE within 3 months. CAM = confusion assessment method, MMSE = mini-mental state examination.
See this image and copyright information in PMC

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