The effect of enhanced recovery after surgery on postoperative delirium in surgical patients: a meta-analysis

Postoperative delirium (POD) is a frequent acute cognitive disorder that occurs after surgery. Enhanced recovery after surgery (ERAS) has been suggested to decrease its incidence. Due to the lack of conclusive evidence on the topic, we conducted a meta-analysis to investigate the potential impact of ERAS on POD.

We included randomized controlled trials involving adult patients undergoing elective surgery. The ERAS group received management based on ERAS principles during the perioperative period, while the control group implemented traditional management strategies. The major evaluation indicators included the incidence of POD, the timing of its first occurrence, and the duration of POD. The secondary evaluation indicators were the content of Mini-Mental State Examination (MMSE) scores, the time to first ambulation, total complication rates, and length of hospital stay.

The results indicated that ERAS significantly reduced the overall incidence of POD (relative risk [RR] = 0.38, P < 0.00001) and the incidence of delirium on the first and second postoperative days (RR = 0.20, P = 0.03; RR = 0.21, P = 0.01). It also delayed the first occurrence of POD (mean difference [MD] = -1.5, P < 0.0001), reduced its duration (MD = -2.15, P = 0.005), improved MMSE scores (MD = 1.95, P < 0.00001), sped up ambulation (MD = -1.53, P < 0.00001), decreased total complication rates (RR = 0.21, P = 0.0003), and shortened hospital stays (MD = -4.61, P < 0.00001).

In conclusion, ERAS significantly reduces POD and related complications while facilitating rapid recovery in surgical patients.