Comparative efficacy and safety of multiple acupoint electrical stimulation therapies for postoperative cognitive dysfunction in cancer patients: a network meta-analysis.

Abstract

Background: Surgery is a primary treatment modality for cancer, yet it is associated with postoperative complications, including postoperative cognitive dysfunction (POCD), which can adversely affect recovery and quality of life. Multiple non-pharmacological approaches, including electroacupuncture (EA), transcutaneous electrical acupoint stimulation (TEAS), and transcutaneous auricular vagus nerve stimulation (taVNS), are employed to mitigate POCD. However, direct comparisons of their relative efficacy are lacking.

Objective: This network meta-analysis aimed to comparatively assess the efficacy of distinct acupoint electrical stimulation modalities-EA, TEAS, and taVNS-in alleviating POCD among surgical oncology patients.

Methods: In accordance with Cochrane guidelines, a systematic review coupled with network meta-analysis was undertaken. Randomized controlled trials (RCTs) investigating acupoint electrical stimulation therapies for POCD in cancer patients were searched in databases including CNKI, Wanfang, VIP, CBM, PubMed, Embase, Web of Science, and Cochrane Library from inception to November 1, 2024. Study quality was assessed using the Cochrane Risk of Bias tool. Network meta-analysis was performed using the BUGSnet package in R 4.3.2. Outcome measures included Mini-Mental State Examination (MMSE) scores and the incidence of POCD on postoperative 1-day, 3-day, and 7-day.

Results: Twenty-three RCTs involving 2055 patients and 6 interventions were included, namely EA, TEAS, taVNS, sham EA, sham TEAS, and blank control. Network meta-analysis revealed that for MMSE scores on postoperative 1-day and 3-day, EA and TEAS showed statistically significant differences compared to blank controls, whereas taVNS did not. By postoperative 7-day, no significant differences were observed among EA, TEAS, taVNS, and blank controls in MMSE scores. For POCD incidence on 1-day and 3-day, EA and TEAS demonstrated significant differences compared to sham EA, sham TEAS, and blank controls. By postoperative 7-day, EA and TEAS remained significantly superior to sham TEAS and blank controls in reducing POCD incidence. Cumulative probability ranking indicated that TEAS had the highest probability of being the best for MMSE scores on 1-day and 3-day, while EA ranked highest for MMSE at 7 days, and for reducing POCD incidence at all time points.

Conclusion: Based on probability rankings, TEAS may be more effective in improving postoperative MMSE scores, whereas EA appears superior in reducing POCD incidence. However, due to modest differences in ranking values and methodological limitations, these findings indicate trends rather than establishing definitive superiority.

Systematic review registration: PROSPERO CRD42024617801.