Accepted for/Published in: JMIR Research Protocols
Date Submitted: Sep 12, 2025
Date Accepted: Nov 28, 2025
Electroacupuncture for the Prevention of Perioperative Neurocognitive Disorder in Elderly Patients Undergoing General Anesthesia: Protocol for Systematic Review and Meta-Analysis
ABSTRACT
Background:
Perioperative neurocognitive disorder (PND) is a prevalent complication among elderly patients undergoing general anesthesia, imposing significant burdens on individuals, healthcare systems, and society. While electroacupuncture (EA) shows promise for PND prevention, current evidence remains inconclusive.
Objective:
To critically evaluate the effectiveness and safety of perioperative EA for PND prevention in elderly surgical patients under general anesthesia.
Methods:
A comprehensive literature search will be conducted in 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. The search strategy aims to identify all relevant randomized controlled trials (RCTs) evaluating perioperative EA for PND prevention in elderly patients (aged ≥60 years) undergoing general anesthesia. The primary outcome will be the incidence of PND. Secondary outcomes will include: (1) neuropsychological assessment scores (Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA]); (2) serum inflammatory biomarkers levels (interleukin-1β [IL-1β], interleukin-6 [IL-6], and tumor necrosis factor-α [TNF-α]); (3) serum neurological damage markers levels (neuron-specific enolase [NSE] and S100 calcium-binding protein β [S100β]); and (4) safety outcomes (incidence of adverse events). Two independent reviewers will perform study selection, data extraction, and methodological quality assessment using RoB 2. All statistical analyses will be conducted in RevMan 5.4, employing suitable meta-analysis models based on heterogeneity testing. The certainty of evidence will be evaluated using GRADE.
Results:
The study selection process will be presented through a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram, detailing the number of records identified, screened, and included. Characteristics of eligible studies will be summarized in evidence tables, including study designs and populations, intervention protocols, outcome measures, etc. The results will be visualized through risk of bias graph, forest plots displaying pooled effect estimates with 95% confidence intervals, and funnel plots for publication bias evaluation (when ≥10 studies are available).
Conclusions:
The effectiveness and safety of perioperative EA for PND prevention in elderly patients undergoing general anesthesia remains indefinite. This systematic review will provide evidence-based evaluation of perioperative EA’s effectiveness in preventing PND, practical recommendations for optimizing geriatric surgical care, and identification of knowledge gaps to guide future research directions. Clinical Trial: PROSPERO CRD420251035172; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251035172
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.