Current Recommendations for Perioperative Brain Health: A Scoping Review.

Area of Science:

• Neuroscience
• Anesthesiology
• Geriatrics

Background:

• Perioperative complications like stroke and neurocognitive dysfunction significantly increase patient morbidity and mortality.
• Contemporary guidelines for managing perioperative brain health in noncardiac, non-neurologic surgery are diverse and require synthesis.

Purpose of the Study:

• To characterize and synthesize current guidelines on perioperative brain health for noncardiac, non-neurologic surgery.
• To identify concordant and discordant recommendations across major guidelines.

Main Methods:

• A scoping review of guidelines published between 2016-2021 focusing on perioperative stroke and neurocognitive disorders.
• Recommendations were categorized by complication, type, and strategy, noting origin, evidence grade, and concordance.

Main Results:

• Eight publications yielded 129 recommendations, with most originating from the US and Europe.
• 42 concordant recommendations were found across 15 themes, including risk factor identification and nonpharmacological prevention strategies.
• 19 discordant recommendations were identified in 7 themes, notably concerning anesthesia type and pharmacological management.

Conclusions:

• Significant agreement exists on risk identification, disclosure, and nonpharmacological prevention of perioperative brain complications.
• Discrepancies in recommendations for stroke prevention monitoring and neurocognitive disorder management require further research.
• High-quality evidence is needed to refine best practices in perioperative brain health.