Intravenous dexmedetomidine for delirium prevention in elderly patients following orthopedic surgery: a meta-analysis of randomized controlled trials.

Objectives: We conducted a meta-analysis to investigate the effect of dexmedetomidine on postoperative delirium in elderly orthopedic surgery patients.

Methods: A meta-analysis was conducted to identify randomized controlled trials of dexmedetomidine in elderly patients undergoing orthopedic surgery. The data was published on October 25, 2024. PubMed, Embase, and Cochrane Library databases were searched. Outcome measures included incidence of delirium, length of hospital stay, visual analogue scale, and postoperative complications. Estimates are expressed as relative risk (RR) or mean difference (MD) with a 95% confidence interval (CI). The publications were reviewed according to the guidelines of the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results: This study was registered with INPLASY (number INPLASY2024110004). A total of 3159 patients were included in 9 randomized controlled trials. The results showed that dexmedetomidine exhibited a preventive effect on delirium compared with the control group in elderly patients after orthopedic surgery (RR: 0.55, 95% CI: 0.45-0.66, P < 0.01, I² = 0%). Subgroup analysis suggested that dexmedetomidine was significantly different from saline(RR: 0.56; 95% CI: 0.44-0.73, P<0.01, I²=31%) and propofol(RR: 0.52; 95% CI: 0.39-0.70, P<0.01, I²=0%) in reducing postoperative delirium in elderly fracture patients. No statistically significant differences were observed in length of hospital stay, visual analogue scale, and postoperative complications (P > 0.05). Certainty of evidence for postoperative delirium was moderate.

Conclusions: Dexmedetomidine has been shown to have a protective effect on postoperative delirium in elderly patients following orthopedic surgery.