# The impact of cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a meta-analysis and economic analysis

## TL;DR

Monitoring cerebral oxygen saturation during surgery reduces postoperative cognitive issues and is cost-effective.

## Contribution

This study provides a comprehensive meta-analysis and economic evaluation of cerebral oxygen saturation monitoring's impact on neurocognitive outcomes.

## Key findings

- Intraoperative rScO2 monitoring significantly reduces the risk of perioperative neurocognitive disorders.
- Monitoring is effective across various surgery types and is supported by robust sensitivity analyses.
- The economic analysis shows rScO2 monitoring is cost-effective with favorable cost-benefit ratios.

## Abstract

Inadequate intraoperative cerebral oxygen supply is one of the inciting causes of postoperative cognitive disturbances. Numerous studies have investigated the association between regional cerebral oxygen saturation (rScO2) monitoring and postoperative cognitive dysfunction. However, results are inconsistent, owing to differences in surgery type, patient population, and monitoring protocols. Therefore, we conducted a meta-analysis to comprehensively evaluate the association between rScO2 monitoring and the incidence of postoperative neurocognitive disorders.

A comprehensive literature search was conducted across multiple databases from their inception to June 2025 to identify randomized controlled trials (RCTs) that compared the impact of rScO2 monitoring versus no monitoring on cognitive function. The primary outcome was the incidence of perioperative neurocognitive disorders (PNDs). Secondary outcomes were the incidences of postoperative cognitive dysfunction (POCD) and postoperative delirium (POD), as well as the economic indicators of the number needed to treat (NNT) and cost–benefit ratio (CBR).

A total of 28 RCTs were included. Overall, we found that intraoperative rScO2 monitoring significantly reduced the incidence risk of PND (relative risk [RR] = 0.47, 95% confidence interval [CI]: 0.41, 0.54), POCD (RR = 0.47, 95% CI: 0.39, 0.57), and POD (RR = 0.45, 95% CI: 0.35, 0.57). Subgroup analyses based on surgery type (cardiac, orthopedic, abdominal, and others) demonstrated consistent protective effects of monitoring. Sensitivity analyses using leave-one-out analysis, excluding Chinese-language publications, low-quality studies, and studies with a baseline rScO2 < 80%, confirmed the robustness of results. The economic evaluation showed that rScO2 monitoring is both clinically beneficial and cost-effective, as reflected in the low NNT values and favorable CBRs, which indicated that the cost of prevention is substantially lower than that of managing complications.

Intraoperative rScO2 monitoring significantly reduces the incidence of PND, including POCD and POD. Consistent protective effects were observed across a wide range of surgery types, demonstrating its broad clinical applicability. Furthermore, its favorable cost–benefit profile demonstrated that the prevention of neurocognitive complications has a substantially lower cost than the estimated economic burden of managing these complications. Widespread adoption of rScO2 monitoring is recommended to improve postoperative cognitive outcomes.