Abstract 4360950: Effect of perioperative benzodiazepine use on postoperative delirium in patients undergoing cardiac surgery: a systematic review and meta-analysis

Abstract

Introduction: Cardiac surgery anesthesia is associated with risks such as postoperative delirium (POD) and stress-related responses. Benzodiazepines have been used perioperatively to reduce anxiety and enhance hemodynamic stability. However, their use may increase the risk of delirium, especially in older adults. Hypothesis: This systematic review and meta-analysis aim to assess the effect of perioperative benzodiazepine use on the incidence of POD in patients undergoing cardiac surgery. Methods: We systematically searched PubMed, Embase, and Cochrane Central for randomized-controlled trials (RCTs) and observational studies comparing benzodiazepines to placebo or non-benzodiazepine drugs in adults undergoing cardiac surgery. The primary outcome was POD. Secondary outcomes included Mini Mental State Examination Score (MMSE), length of intensive care unit (ICU), and time to extubation. For dichotomous outcomes, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, while mean differences (MDs) were used for continuous outcomes. All statistical analyses were performed using R software version 4.4.3. Results: Eight studies were included, comprising 36,301 patients, of whom 20,747 (68.5%) received benzodiazepines. The prescription of benzodiazepines was associated with similar incidence of POD compared to the control group (OR 1.05; 95% CI: 0.88 to 1.25; p=0.55; I 2 =83%; Figure 1). Similarly, there were no significant difference in MMSE score (MD -0.11; 95% CI: -3.17 to 2.95; p=0.94; I 2 =70%), ICU length of stay (MD 4.72 hours; 95% CI: -1.37 to 10.80; p=0.13; I 2 =99%), and time to extubation (MD -0.53 hours; 95% CI: -2.16 to 1.09; p=0.52; I 2 =72%) between the two protocols as shown in Figure 2. Conclusion: This meta-analysis found no significant association between perioperative benzodiazepine use and the incidence of POD in adults undergoing cardiac surgery. Additionally, no significant differences were observed in MMSE scores, ICU length of stay, or time to extubation.