Interventions to prevent postoperative neurocognitive complications: an umbrella review of meta-analyses of randomised controlled trials.

Abstract

The certainty of the effectiveness of interventions to manage postoperative neurocognitive complications remains unclear. The objective of this umbrella review was to synthesise and evaluate the evidence for interventions aimed at reducing the incidence of peri-operative neurocognitive complications. We searched relevant databases from inception to 23 August 2025. We included systematic reviews and meta-analyses of randomised trials evaluating pharmacological and non-pharmacological interventions for the prevention of postoperative neurocognitive complications in adult surgical populations. Certainty of evidence for each intervention was assessed using the GRADE framework. Methodological quality was appraised using AMSTAR and the Ioannidis classification. A total of 114 systematic reviews and meta-analyses, with data from 250,777 patients, were included. Dexmedetomidine, cerebral monitoring, acupuncture, sleep interventions, steroids, antipsychotics, peripheral nerve blocks, esketamine and remimazolam were associated with reductions in postoperative neurocognitive complications. Subgroup analyses indicated that these interventions also showed potential benefits across non-cardiac, orthopaedic and cardiac surgery. However, the overall certainty of evidence for all these interventions was predominantly very low. A number of peri-operative interventions are associated with a reduction in postoperative neurocognitive complications but the certainty of evidence supporting these interventions to prevent is very low. High-quality research is needed to advance the evidence base and inform future clinical practice.