Effect of Perioperative Benzodiazepine Use on Postoperative Delirium in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.

INTRODUCTION: Cardiac surgery anesthesia is associated with risks such as postoperative delirium (POD) and stress-related responses. Benzodiazepines have been used perioperatively to reduce anxiety and promote hemodynamic control. However, their use may increase the risk of delirium, particularly in older adults. This systematic review and meta-analysis aims to evaluate the impact of perioperative benzodiazepine use on the incidence of POD in patients undergoing cardiac surgery. METHODS: We systematically searched for randomized controlled trials (RCTs) and observational studies comparing benzodiazepines with placebo or nonbenzodiazepine drugs in adults undergoing cardiac surgery. The primary outcome was POD incidence; secondary outcomes included mini-mental state examination (MMSE), ICU length of stay, and time to extubation. For dichotomous outcomes, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, while mean differences (MDs) were used for continuous outcomes. Analyses were performed using R 4.4.3. RESULTS: Eight studies were included, comprising 36,301 patients, of whom 20,747 (68.5%) received benzodiazepines. Follow-up ranged from 1 day to 12 months. There were no significant differences between groups in the incidence of POD (OR 1.05; 95% CI: 0.88 to 1.25; p = 0.55; I2 = 83%). Similarly, there were no significant difference in MMSE score (MD -0.11; 95% CI: -3.17 to 2.95; p = 0.94; I2 = 70%), ICU length of stay (MD 4.72 h; 95% CI: -1.37 to 10.80; p = 0.13; I2 = 99%), and time to extubation (MD -0.53 h; 95% CI: -2.16 to 1.09; p = 0.52; I2 = 72%). CONCLUSION: Perioperative benzodiazepine use was not significantly associated with POD or with secondary outcomes in adults undergoing cardiac surgery.