{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:43:57Z","timestamp":1786653837675,"version":"build-2736575974"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Postoperative neurocognitive dysfunction (PNCD) commonly occurs after surgery and prolongs hospital stays. Both direct noxious stimuli to the central nervous system and systemic inflammation have been implicated. Due to their potent anti-inflammatory effects, corticosteroids have been utilised to attenuate the incidence and severity of PNCD. This systematic review and meta-analysis strived to evaluate the prophylactic role of perioperative corticosteroids for PNCD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A search was run in pre-defined databases for randomised controlled trials (RCTs) assessing the role of corticosteroids in preventing PNCD. The incidence of PNCD within 1 month was the primary outcome. Secondary outcomes included the use of antipsychotic medications for the treatment, postoperative infection, and hospital length of stay. The results are exhibited as odds ratio (OR) and the mean difference (MD) with 95% confidence interval (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Fifteen RCTs comprising 15,398 patients were included. The incidence of PNCD was significantly lower in the corticosteroid group than in the control group, with a pooled OR of 0.75 (95% CI 0.58, 0.96;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.02; I\n                      <jats:sup>2<\/jats:sup>\n                      = 66%). Trial sequential analysis showed the clinical benefit of corticosteroids in preventing PNCD; however, the requisite information size is still inadequate. The sub-group analysis supported the prophylactic effect of corticosteroids on delirium prevention but not on delayed neurocognitive recovery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Our meta-analysis revealed statistically significant protective effects of corticosteroids on the incidence of PNCD. However, further studies are still needed to confirm the protective role of this commonly used and relatively safe strategy for preventing PNCD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ija.ija_149_24","type":"journal-article","created":{"date-parts":[[2024,5,7]],"date-time":"2024-05-07T07:00:49Z","timestamp":1715065249000},"page":"517-526","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Effect of prophylactic corticosteroids on postoperative neurocognitive dysfunction in the adult population: An updated systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials"],"prefix":"10.4103","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1538-8728","authenticated-orcid":false,"given":"Narinder P.","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8159-5920","authenticated-orcid":false,"given":"Jeetinder K.","family":"Makkar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6572-0311","authenticated-orcid":false,"given":"Nitika","family":"Goel","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3089-8088","authenticated-orcid":false,"given":"Kunal","family":"Karamchandani","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Management, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3393-8586","authenticated-orcid":false,"given":"Mandeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7642-529X","authenticated-orcid":false,"given":"Preet M.","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Washington University in Saint Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,5,8]]},"reference":[{"key":"R1-20260504","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet"},{"key":"R2-20260504","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.bja.2019.07.004","article-title":"State of the clinical science of perioperative brain health: Report from the American Society of Anesthesiologists brain health initiative summit 2018","volume":"123","author":"Mahanna-Gabrielli","year":"2019","journal-title":"Br J Anaesth"},{"key":"R3-20260504","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.jamcollsurg.2014.10.019","article-title":"Postoperative delirium in older adults: Best practice statement from the American Geriatrics Society","volume":"220","year":"2015","journal-title":"J Am Coll Surg"},{"key":"R4-20260504","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1213\/ANE.0000000000003634","article-title":"Recommendations for the nomenclature of cognitive change associated with anesthesia and surgery-2018","volume":"127","author":"Evered","year":"2018","journal-title":"Anesth Analg"},{"key":"R5-20260504","doi-asserted-by":"crossref","first-page":"106063","DOI":"10.1016\/j.ijsu.2021.106063","article-title":"Risk factors for postoperative delirium: An umbrella review of systematic reviews","volume":"93","author":"Bramley","year":"2021","journal-title":"Int J Surg"},{"key":"R6-20260504","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1001\/jamasurg.2015.2606","article-title":"Effect of delirium and other major complications on outcomes after elective surgery in older adults","volume":"150","author":"Gleason","year":"2015","journal-title":"JAMA Surg"},{"key":"R7-20260504","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1001\/archinternmed.2007.4","article-title":"One-year health care costs associated with delirium in the elderly population","volume":"168","author":"Leslie","year":"2008","journal-title":"Arch Intern Med"},{"issue":"Suppl 1","key":"R8-20260504","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/anae.15607","article-title":"Evidence-based strategies to reduce the incidence of postoperative delirium: A narrative review","volume":"77","author":"Swarbrick","year":"2022","journal-title":"Anaesthesia"},{"key":"R9-20260504","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.bja.2021.11.041","article-title":"Influence of perioperative dexmedetomidine on the incidence of postoperative delirium in adult patients undergoing cardiac surgery","volume":"129","author":"Patel","year":"2022","journal-title":"Br J Anaesth"},{"key":"R10-20260504","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1097\/ALN.0000000000003016","article-title":"Intraoperative oxidative damage and delirium after cardiac surgery","volume":"132","author":"Lopez","year":"2020","journal-title":"Anesthesiology"},{"key":"R11-20260504","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/s12871-019-0783-x","article-title":"Effects of dexamethasone on postoperative cognitive dysfunction and delirium in adults following general anaesthesia: A meta-analysis of randomised controlled trials","volume":"19","author":"Li","year":"2019","journal-title":"BMC Anesthesiol"},{"key":"R12-20260504","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1016\/j.clinthera.2021.07.021","article-title":"Effects of glucocorticoids on postoperative delirium in adult patients undergoing cardiac surgery: A systematic review and meta-analysis","volume":"43","author":"Liu","year":"2021","journal-title":"Clin Ther"},{"key":"R13-20260504","doi-asserted-by":"crossref","first-page":"939848","DOI":"10.3389\/fnagi.2022.939848","article-title":"Effects of glucocorticoids on postoperative neurocognitive disorders in adult patients: A systematic review and meta-analysis","volume":"14","author":"Xie","year":"2022","journal-title":"Front Aging Neurosci"},{"key":"R14-20260504","first-page":"167","article-title":"What is your research question? An introduction to the PICOT format for clinicians","volume":"56","author":"Riva","year":"2012","journal-title":"J Can Chiropr Assoc"},{"key":"R15-20260504","doi-asserted-by":"crossref","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"R16-20260504","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1471-2288-5-13","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"5","author":"Hozo","year":"2005","journal-title":"BMC Med Res Methodol"},{"key":"R17-20260504","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomized trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"R18-20260504","article-title":"GRADEpro GDT: GRADEpro Guideline Development Tool [Software]","journal-title":"McMaster University, 2015 (developed by Evidence Prime, Inc.)"},{"key":"R19-20260504","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"R20-20260504","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1111\/anae.14406","article-title":"Effect of a single pre-operative 125 mg dose of methylprednisolone on postoperative delirium in hip fracture patients; A randomised, double-blind, placebo-controlled trial","volume":"73","author":"Clemmesen","year":"2018","journal-title":"Anaesthesia"},{"key":"R21-20260504","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1001\/jama.2012.14144","article-title":"Intraoperative high-dose dexamethasone for cardiac surgery: A randomized controlled trial","volume":"308","author":"Dieleman","year":"2012","journal-title":"JAMA"},{"key":"R22-20260504","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/ANA.0000000000000024","article-title":"Higher dose dexamethasone increases early postoperative cognitive dysfunction","volume":"26","author":"Fang","year":"2014","journal-title":"J Neurosurg Anesthesiol"},{"key":"R23-20260504","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/s00264-020-04802-8","article-title":"The effect of pre-operative high doses of methylprednisolone on pain management and convalescence after total hip replacement in elderly: A double-blind randomized study","volume":"45","author":"G\u0105dek","journal-title":"Int Orthop"},{"key":"R24-20260504","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1097\/EJA.0000000000000647","article-title":"Effects of dexamethasone on early cognitive decline after cardiac surgery: A randomised controlled trial","volume":"34","author":"Glumac","year":"2017","journal-title":"Eur J Anaesthesiol"},{"key":"R25-20260504","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1515\/revneuro-2012-0058","article-title":"Glucocorticoid-endocannabinoid interaction in cardiac surgical patients: Relationship to early cognitive dysfunction and late depression","volume":"23","author":"Hauer","year":"2012","journal-title":"Rev Neurosci"},{"key":"R26-20260504","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1111\/anae.15465","article-title":"Steroids to reduce the impact on delirium (STRIDE): A double-blind, randomised, placebo-controlled feasibility trial of pre-operative dexamethasone in people with hip fracture","volume":"76","author":"Kluger","year":"2021","journal-title":"Anaesthesia"},{"key":"R27-20260504","first-page":"137","article-title":"Prophylaxis of dexamethasone protects patients from further post-operative delirium after cardiac surgery: A randomized trial","volume":"18","author":"Mardani","year":"2013","journal-title":"J Res Med Sci"},{"key":"R28-20260504","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1097\/ALN.0000000000000336","article-title":"Effects of dexamethasone on cognitive decline after cardiac surgery: A randomized clinical trial","volume":"121","author":"Ottens","year":"2014","journal-title":"Anesthesiology"},{"key":"R29-20260504","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s12871-015-0130-9","article-title":"Postoperative cognitive dysfunction after inhalational in elderly patients undergoing major surgery: The influence of anesthetic technique, cerebral injury and systemic inflammation","volume":"15","author":"Qiao","year":"2015","journal-title":"BMC Anesthesiol"},{"key":"R30-20260504","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/ALN.0000000000001433","article-title":"Impact of methylprednisolone on postoperative quality of recovery and delirium in the steroids in cardiac surgery trial: A randomized, double-blind, placebo-controlled substudy","volume":"126","author":"Royse","year":"2017","journal-title":"Anesthesiology"},{"key":"R31-20260504","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1213\/ANE.0000000000000248","article-title":"Intraoperative dexamethasone and delirium after cardiac surgery: A randomized clinical trial","volume":"119","author":"Sau\u00ebr","year":"2014","journal-title":"Anesth Analg"},{"key":"R32-20260504","doi-asserted-by":"crossref","first-page":"e0152308","DOI":"10.1371\/journal.pone.0152308","article-title":"Effects of single low dose of dexamethasone before noncardiac and nonneurologic surgery and general anesthesia on postoperative cognitive dysfunction-A phase III double blind, randomized clinical trial","volume":"11","author":"Valentin","year":"2016","journal-title":"PLoS One"},{"key":"R33-20260504","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1016\/S0140-6736(15)00273-1","article-title":"Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): A randomised, double-blind, placebo-controlled trial","volume":"386","author":"Whitlock","year":"2015","journal-title":"Lancet"},{"key":"R34-20260504","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1093\/gerona\/glab248","article-title":"The effect of preoperative methylprednisolone on postoperative delirium in older patients undergoing gastrointestinal surgery: A randomized, double-blind, placebo-controlled trial","volume":"77","author":"Xiang","year":"2022","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"R35-20260504","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1097\/ALN.0000000000003898","article-title":"Benefits and risks of dexamethasone in noncardiac surgery","volume":"135","author":"Myles","year":"2021","journal-title":"Anesthesiology"},{"key":"R36-20260504","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1213\/ANE.0000000000004641","article-title":"American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention","volume":"130","author":"Hughes","year":"2020","journal-title":"Anesth Analg"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_149_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:43:08Z","timestamp":1786650188000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_149_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,8]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_149_24","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,8]]},"assertion":[{"value":"2024-02-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}