DOI: 10.1097/js9.0000000000005541 ISSN: 1743-9159

Perioperative dexmedetomidine for the prevention of postoperative delirium in elderly patients undergoing orthopedic surgery: a systematic review and meta-analysis of randomized controlled trials

Syed Faqeer Hussain Bokhari, Affaf Mahmood, Saira Shamim, Khansa Mehmood, Rabia Amjad, Abdul Saboor Khan, Aiman Jeet Kaur, Ibrahim Salau, Fnu Maryam, Ahmad Hassan, Muhammad Numan Awais, Asma Iqbal
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Background:

Postoperative delirium (POD) is a frequent and morbid complication in elderly patients undergoing orthopedic surgery. Although dexmedetomidine has been studied for delirium prevention in mixed surgical populations, evidence specific to orthopedic procedures and perioperative administration strategies remains fragmented.

Objective:

To evaluate the efficacy and cardiovascular safety of perioperative dexmedetomidine for POD prevention in elderly patients undergoing orthopedic surgery and to examine its impact on recovery outcomes.

Methods:

A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials (RCTs) comparing perioperative dexmedetomidine with placebo or standard care in adults undergoing orthopedic surgery was conducted. The primary outcome was POD incidence. Secondary outcomes included time-specific delirium, perioperative cardiovascular adverse events, length of hospital stay, in-hospital complications, and mortality.

Results:

Seven RCTs, including 2060 patients, were analyzed. Dexmedetomidine significantly reduced overall POD incidence [odds ratio (OR) = 0.42; 95% CI 0.32–0.54; I 2  = 0%; P < 0.00001]. Time-specific reductions were observed at 24 h (OR = 0.36; 95% CI 0.22–0.57; P < 0.0001) and 72 h (OR = 0.46; 95% CI 0.24–0.87; P = 0.02), but not at 48 h (OR = 0.38; 95% CI 0.12–1.15; P = 0.09). Intraoperative cardiovascular adverse events were increased overall (OR = 1.65; 95% CI 1.10–2.47; P = 0.02), while individual events were not significantly different. Postoperatively, hypertension was reduced (OR = 0.52; 95% CI 0.30–0.91; P = 0.02). Hospital stay was significantly shorter (mean difference = −1.31 days; 95% CI −1.93 to −0.69; P < 0.0001), with no significant differences in in-hospital complications (OR = 0.74; P = 0.06) or mortality (OR = 0.89; P = 0.83).

Conclusion:

Perioperative dexmedetomidine reduces POD and improves recovery in elderly orthopedic patients, with manageable cardiovascular effects under monitoring. Further large-scale trials are needed to determine optimal dosing, timing, and long-term neurocognitive outcomes.

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