Prevention of Postoperative Delirium in Patients Undergoing Elective Surgery Using Multicomponent Interventions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

<h4>Background and hypothesis</h4>Postoperative delirium (POD) is a common acute cognitive disorder among older adults following elective surgery. It prolongs hospitalization, increases the risk of complications and readmission, and may contribute to long-term cognitive decline, thereby reducing patients' quality of life. Although various preventive strategies have been developed, single interventions often yield limited efficacy. This study systematically evaluates, through meta-analysis, the effectiveness of multicomponent interventions in preventing POD among older adults undergoing elective surgery.<h4>Study design</h4>A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) published through July 2025. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess intervention effects, and pooled analyses were performed using a random-effects model.<h4>Study results</h4>Eleven RCTs comprising 3857 patients undergoing elective surgery were included in the final analysis. Multicomponent interventions significantly reduced POD incidence in older adults (RR: 0.71; 95% CI: 0.59-0.85; p < 0.001), representing a 29% risk reduction. Between-study heterogeneity was low (I² = 18.0%, p = 0.272). Sensitivity analyses supported the robustness of results. Subgroup analyses indicated a greater effect in Eastern populations compared to Western populations (interaction p = 0.045).<h4>Conclusions</h4>Multicomponent interventions are effective in reducing POD incidence in older adults undergoing elective surgery, with geographical variation influencing effect size. These findings support broader clinical adoption of such interventions for POD prevention.