Effects of non-pharmacological interventions on post-operative delirium in cardiac surgery patients: a systematic review and network meta-analysis

Aims Although non-pharmacological interventions (NPIs) are important for preventing post-operative delirium, their comparative effectiveness in cardiac surgery patients remains unclear. This study aimed to compare different NPIs and identify the most effective strategy using a network meta-analysis (NMA). Methods and results Randomized controlled trials (RCTs) were identified through systematic searches of PubMed, Web of Science, Embase, CINAHL, Cochrane Library, CNKI, Wanfang Data, and the VIP Database. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. NMA was conducted using Stata 18.0. Post-operative delirium incidence was summarized as odds ratios with 95% confidence intervals (CIs), and delirium duration as mean differences (MDs) with 95% CIs. A total of 26 RCTs (n = 2913) were included. Overall, NPIs were associated with a reduced incidence of post-operative delirium compared with routine care (OR = 0.42, 95% CI = 0.34–0.50, P < 0.05, I2= 51%). In the NMA, multicomponent therapy (OR = 0.30, 95% CI = 0.19–0.47) and health education (OR = 0.33, 95% CI = 0.12–0.88) significantly reduced delirium incidence. NPIs also shortened delirium duration (MD = −0.96, 95% CI = −1.06 to −0.86, P < 0.05, I2 = 0%), with multicomponent therapy showing the greatest reduction. Conclusion NPIs reduce the incidence and duration of post-operative delirium in patients undergoing cardiac surgery, with multicomponent therapy combining several non-pharmacological strategies targeting different modifiable risk factors, such as delirium assessment, clinical adjustment, environmental control, and early mobilization, showing the most favourable effects. Review registration PROSPERO: CRD420250655564.