# Electroacupuncture for the prevention of perioperative neurocognitive disorder in elderly patients undergoing general anesthesia: a systematic review and meta-analysis

## TL;DR

This study finds that electroacupuncture may help reduce cognitive issues in elderly patients after surgery under general anesthesia.

## Contribution

The study provides a systematic review and meta-analysis of electroacupuncture's effectiveness in preventing perioperative neurocognitive disorder in elderly patients.

## Key findings

- Electroacupuncture significantly reduces the incidence of perioperative neurocognitive disorder in elderly patients.
- It improves cognitive scores and lowers inflammatory biomarkers like IL-6, IL-1β, and TNF-α.
- Electroacupuncture is associated with fewer adverse events compared to control interventions.

## Abstract

Perioperative neurocognitive disorder (PND) is a common complication following major surgery under general anesthesia, particularly among elderly patients, and adversely impacts postoperative recovery and quality of life. Although electroacupuncture (EA) has shown potential in preventing PND, conclusive evidence remains lacking. This study aimed to evaluate the effectiveness and safety of perioperative EA intervention for preventing PND in elderly patients undergoing general anesthesia surgery.

We systematically searched eight electronic databases [PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chongqing VIP Chinese Science and Technology Periodical Database (CQVIP), Wan Fang Database, and China Biology Medicine disc (CBM)] and three clinical trial registries from inception to March 16, 2025. Eligible studies were randomized controlled trials (RCTs) investigating perioperative EA for PND prevention in patients aged ≥ 60 years receiving general anesthesia. Control interventions included sham EA, standard care, or no intervention. Primary outcome was PND incidence. Secondary outcomes included neuropsychological assessment scores [Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)], inflammatory biomarkers [serum interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels], neurological damage markers [serum neuron-specific enolase (NSE), S100 calcium-binding protein β (S100β) levels], and safety outcomes (incidence of adverse events). Two reviewers independently performed blind screening, data extraction, and risk-of-bias assessment using the Cochrane RoB 2 tool. Meta-analyses were conducted using RevMan 5.4, with random-effects or fixed-effect models applied based on heterogeneity (I2 statistics). The certainty of evidence was evaluated with the GRADE.

Twenty-six RCTs (n = 2,309) were included. Compared to the control groups, perioperative EA significantly reduced the incidence of PND (RR = 0.47, 95% CI: 0.42 to 0.54, p < 0.00001; I2 = 0%; moderate to low certainty), improved MMSE scores (MD = 1.92, 95% CI: 1.59 to 2.26, p < 0.00001; I2 = 96%; low to very low certainty), lowered serum IL-6 (SMD = −1.09, 95% CI: −1.73 to −0.44, p = 0.0010; I2 = 88%; very low certainty), IL-1β (SMD = −2.85, 95% CI: −5.32 to −0.39, p = 0.02; I2 = 99%; very low certainty), TNF-α (SMD = −2.64, 95% CI: −4.16 to −1.12, p = 0.0007; I2 = 98%; low certainty), and S100β (SMD = −1.56, 95% CI: −2.77 to −0.35, p = 0.01; I2 = 97%; low certainty) levels, and reduced adverse events (RR = 0.52, 95% CI: 0.37 to 0.72, p < 0.0001; I2 = 0%; moderate certainty). MoCA scores and serum NSE levels could not be meta-analyzed due to insufficient data.

Perioperative EA intervention demonstrates significant clinical benefits in elderly patients undergoing general anesthesia surgery, effectively reducing PND incidence, improving cognitive function, attenuating neuroinflammation, and reducing neurological injury with a favorable safety profile. However, current evidence is constrained by methodological limitations, including potential selection bias and insufficient blinding in the included studies. Future rigorously designed multicenter RCTs with standardized EA featuring standardized EA protocols and long-term cognitive monitoring are needed to confirm its neuroprotective effects.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251035172.