The Use of Cerebral Oximetry in Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

OBJECTIVE\nThe evidence on the use of cerebral oximetry during surgery to minimize postoperative neurologic complications remains uncertain in the literature. The present authors aimed to assess the value of cerebral oximetry in the prevention of postoperative cognitive dysfunction, postoperative delirium, and postoperative stroke in adults undergoing surgery.\n\n\nDESIGN\nA systematic review and meta-analysis.\n\n\nSETTING\nThe surgery room.\n\n\nPARTICIPANTS\nAdult patients (ages ≥18 years) undergoing surgery.\n\n\nINTERVENTIONS\nCerebral oximetry monitoring.\n\n\nMEASUREMENTS AND MAIN RESULTS\nDatabases of Ovid MEDLINE, Ovid EMBASE, and CENTRAL were systematically searched from their inception until December 2020 for randomized controlled trials comparing cerebral oximetry monitoring with either blinded or no cerebral oximetry monitoring in adults undergoing surgery. Observational studies, case reports, and case series were excluded. Seventeen studies (n\xa0=\xa02,120 patients) were included for quantitative meta-analysis. Patients who were randomized to cerebral oximetry monitoring had a lower incidence of postoperative cognitive dysfunction (studies\xa0=\xa0seven, n\xa0=\xa0969, odds ratio [OR] 0.23, 95% confidence interval [CI] 0.11-0.48, p\xa0=\xa00.0001; evidence\xa0=\xa0very low). However, no significant differences were observed in the incidence of postoperative delirium (studies\xa0=\xa0five, n\xa0=\xa0716, OR 0.81, 95% CI 0.53-1.25, p\xa0=\xa00.35; evidence\xa0=\xa0high), and postoperative stroke (studies\xa0=\xa0seven, n\xa0=\xa01,087, OR 0.72, 95% CI 0.30-1.69, p\xa0=\xa00.45; evidence\xa0=\xa0moderate).\n\n\nCONCLUSION\nAdult patients with cerebral oximetry monitoring were associated with a significant reduction of postoperative cognitive dysfunction. However, given the low certainty of evidence and substantial heterogeneity, more randomized controlled trials using standardized assessment tools for postoperative cognitive dysfunction and interventions of correcting cerebral desaturation are warranted to improve the certainty of evidence and homogeneity.