The correlation of intraoperative hypotension and postoperative cognitive impairment: a meta-analysis of randomized controlled trials

Xiaojin Feng, Jialing Hu, Fuzhou Hua, Jing Zhang, Lieliang Zhang, Guohai Xu, Xiaojin Feng, Jialing Hu, Fuzhou Hua, Jing Zhang, Lieliang Zhang, Guohai Xu

Abstract

Background: There is no consensus on whether intraoperative hypotension is associated with postoperative cognitive impairment. Hence, we performed a meta-analysis to evaluate the correlation of intraoperative hypotension and the incidence of postoperative delirium (POD) or postoperative cognitive dysfunction (POCD).

Methods: We searched PubMed, Embase, and Cochrane Library databases to find randomized controlled trials (RCTs) in which reported the relationship between intraoperative hypotension and POD or POCD. The retrieval time is up to January 2020, without language restrictions. Quality assessment of the eligible studies was conducted by two researchers independently with the Cochrane evaluation system.

Results: We analyzed five eligible RCTs. Based on the relative mean arterial pressure (MAP), participants were divided into low-target and high-target groups. For the incidence of POD, there were two studies with 99 participants in the low-target group and 94 participants in the high-target pressure group. For the incidence of POCD, there were four studies involved 360 participants in the low-target group and 341 participants in the high-target group, with a study assessed both POD and POCD. No significant difference between the low-target and the high-target group was observed in the incidence of POD (RR = 3.30, 95% CI 0.80 to 13.54, P = 0.10), or POCD (RR = 1.26, 95% CI 0.76 to 2.08, P = 0.37). Furthermore, it also demonstrates that intraoperative hypotension prolonged the length of ICU stay, but did not increased the mortality, the length of hospital stay, and mechanical ventilation (MV) time.

Conclusions: There is no significant correlation between intraoperative hypotension and the incidence of POD or POCD.

Keywords: Intraoperative hypotension; Meta-analysis; Postoperative cognitive dysfunction; Postoperative delirium.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA diagram of study selection in this meta-analysis
Fig. 2
Fig. 2
Risk of bias assessment for each study
Fig. 3
Fig. 3
Forest plot of primary outcome - incidence of POD
Fig. 4
Fig. 4
Forest plot of primary outcome - incidence of POCD
Fig. 5
Fig. 5
Subgroup analysis of cardiac surgery versus non-cardiac surgery
Fig. 6
Fig. 6
Subgroup analysis of general anesthesia versus epidural anesthesia

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