Key result
Postoperative neurocognitive disorder affects ~23% of older non-cardiac surgical patients at one week.
Why the study?
Previous reviews estimated postoperative neurocognitive disorder prevalence without accounting for sample size or study quality, leaving the true prevalence in older non-cardiac surgical patients unclear.
Meta-Analysis (n=12,921)
Postoperative neurocognitive disorder is common in older non-cardiac surgical patients, affecting 23% at 7 days and 10% at 3 months, with higher rates in abdominal versus orthopedic surgeries.
Supports cognitive screening and risk mitigation in older noncardiac surgery patients; leaves open targeted prevention trials.
STUDY OBJECTIVE: The growing number of older persons undergoing surgery are at a higher risk of neurocognitive disorder due to multimorbidity and age-related changes. Previous reviews estimated postoperative neurocognitive disorder or cognitive dysfunction (POCD) prevalence without accounting for the sample size or study quality. The prevalence of POCD in this population requires further investigation. This systematic review and meta-analysis applies systematic weighting to estimate the pooled prevalence of POCD in older non-cardiac surgical patients. DESIGN: Systematic review and meta-analysis. SETTING: MEDLINE, MEDLINE ePub, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews for relevant articles. PATIENTS: Non-cardiac surgical patients aged ≥60 years old. INTERVENTIONS: Perioperative cognitive assessments. MEASUREMENT: The primary outcome was the prevalence of POCD. MAIN RESULTS: Thirty-nine studies (n = 12,921) were included with mean age of 70.0 ± 8.9 years and 44.3 % women. The overall prevalence of POCD was 23 % (95 % CI: 20 %, 27 %) at day 7, 16 % (95 % CI: 7 %, 25 %) at 1 month, 10 % (95 % CI: 8 %, 13 %) at 3 months and 3 % (95 % CI: 2 %, 4 %) at 1 year. Our meta-regression showed a higher prevalence of POCD in abdominal surgeries at day 7 (β = 0.13, 95 % CI: 0.03-0.22, P = 0.01) and 3 months (β = 0.49, 95 % CI: 0.40-0.58, P < 0.001), versus orthopedic surgeries. CONCLUSIONS: The overall prevalence of POCD in older non-cardiac surgical populations was 23 %, 16 %, 10 %, and 3 % at day 7, 1 month, 3 months, and 1 year, respectively. Abdominal surgery had a higher prevalence of POCD than orthopedic surgery. The substantial risk of POCD calls for cognitive screening, risk mitigation and interventions to improve surgical outcomes. Through routine preoperative cognitive screening and addressing modifiable risk factors, the incidence and impact of POCD can be markedly reduced, enhancing patient outcomes and recovery.
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Fan et al. (2025) conducted a meta-analysis in Non-cardiac surgery (n=12,921). Non-cardiac surgery was evaluated on prevalence of POCD at day 7 (95% CI 20-27). The overall prevalence of postoperative neurocognitive disorder in older non-cardiac surgical patients was 23% (95% CI 20-27%) at day 7, declining to 3% at 1 year.
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