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Study flow diagram.
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Figure 1

Study flow diagram.

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Study flow diagram‐top up search on November 2017.
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Figure 2

Study flow diagram‐top up search on November 2017.

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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 3

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
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Figure 4

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score).
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Analysis 1.1

Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score).

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Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 2 POCD defined by original studies ‐ 1 week.
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Analysis 1.2

Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 2 POCD defined by original studies ‐ 1 week.

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Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 3 POCD: decline in cognitive function ‐ 1 week.
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Analysis 1.3

Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 3 POCD: decline in cognitive function ‐ 1 week.

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Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 4 Intraoperative mortality or postoperative mortality: Death.
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Analysis 1.4

Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 4 Intraoperative mortality or postoperative mortality: Death.

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Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 5 The occurrence of abnormal rScO2 during or after surgery: Desaturation.
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Analysis 1.5

Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 5 The occurrence of abnormal rScO2 during or after surgery: Desaturation.

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Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 6 Any major non‐neurological complications as defined by individual study.
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Analysis 1.6

Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 6 Any major non‐neurological complications as defined by individual study.

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Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 7 Length of ICU stay (days).
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Analysis 1.7

Comparison 1 Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring, Outcome 7 Length of ICU stay (days).

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Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 1 Postoperative stroke or other neurological injury: Neurological injury.
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Analysis 2.1

Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 1 Postoperative stroke or other neurological injury: Neurological injury.

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Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 2 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 1 week.
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Analysis 2.2

Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 2 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 1 week.

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Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 3 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 12 weeks.
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Analysis 2.3

Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 3 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 12 weeks.

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Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 4 POCD defined by original studies ‐ 1 week ‐ mild.
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Analysis 2.4

Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 4 POCD defined by original studies ‐ 1 week ‐ mild.

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Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 5 POCD defined by original studies ‐ 1 week ‐ severe.
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Analysis 2.5

Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 5 POCD defined by original studies ‐ 1 week ‐ severe.

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Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 6 POCD: decline in cognitive function ‐ 1 week.
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Analysis 2.6

Comparison 2 Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery, Outcome 6 POCD: decline in cognitive function ‐ 1 week.

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Comparison 3 Subgroup of interventions: cerebral oxygenation monitoring (EQUANOX) or INVOS vs blinded monitoring, Outcome 1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 1 week.
Figuras y tablas -
Analysis 3.1

Comparison 3 Subgroup of interventions: cerebral oxygenation monitoring (EQUANOX) or INVOS vs blinded monitoring, Outcome 1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 1 week.

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Comparison 3 Subgroup of interventions: cerebral oxygenation monitoring (EQUANOX) or INVOS vs blinded monitoring, Outcome 2 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 12 weeks.
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Analysis 3.2

Comparison 3 Subgroup of interventions: cerebral oxygenation monitoring (EQUANOX) or INVOS vs blinded monitoring, Outcome 2 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 12 weeks.

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Comparison 3 Subgroup of interventions: cerebral oxygenation monitoring (EQUANOX) or INVOS vs blinded monitoring, Outcome 3 POCD: decline in cognitive function ‐ 1 week.
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Analysis 3.3

Comparison 3 Subgroup of interventions: cerebral oxygenation monitoring (EQUANOX) or INVOS vs blinded monitoring, Outcome 3 POCD: decline in cognitive function ‐ 1 week.

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Comparison 4 Sensitivity analysis: detection bias, Outcome 1 Any major non‐neurological complications as defined by individual study: including studies with detection bias.
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Analysis 4.1

Comparison 4 Sensitivity analysis: detection bias, Outcome 1 Any major non‐neurological complications as defined by individual study: including studies with detection bias.

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Comparison 4 Sensitivity analysis: detection bias, Outcome 2 Any major non‐neurological complications as defined by individual study: including studies without detection bias.
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Analysis 4.2

Comparison 4 Sensitivity analysis: detection bias, Outcome 2 Any major non‐neurological complications as defined by individual study: including studies without detection bias.

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Comparison 5 Sensitivity analysis: missing data, Outcome 1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies with missing data.
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Analysis 5.1

Comparison 5 Sensitivity analysis: missing data, Outcome 1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies with missing data.

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Comparison 5 Sensitivity analysis: missing data, Outcome 2 POCD: decline in cognitive function ‐ 1 week: including studies with missing data.
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Analysis 5.2

Comparison 5 Sensitivity analysis: missing data, Outcome 2 POCD: decline in cognitive function ‐ 1 week: including studies with missing data.

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Comparison 5 Sensitivity analysis: missing data, Outcome 3 Occurrence of abnormal rScO2 during or after surgery: Desaturation: including studies with missing data.
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Analysis 5.3

Comparison 5 Sensitivity analysis: missing data, Outcome 3 Occurrence of abnormal rScO2 during or after surgery: Desaturation: including studies with missing data.

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Comparison 5 Sensitivity analysis: missing data, Outcome 4 Any major non‐neurological complications as defined by individual study: including studies with missing data.
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Analysis 5.4

Comparison 5 Sensitivity analysis: missing data, Outcome 4 Any major non‐neurological complications as defined by individual study: including studies with missing data.

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Comparison 5 Sensitivity analysis: missing data, Outcome 5 POCD: decline in cognitive function ‐ 1 week: without missing data.
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Analysis 5.5

Comparison 5 Sensitivity analysis: missing data, Outcome 5 POCD: decline in cognitive function ‐ 1 week: without missing data.

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Comparison 5 Sensitivity analysis: missing data, Outcome 6 Occurrence of abnormal rScO2 during or after surgery: Desaturation: without missing data.
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Analysis 5.6

Comparison 5 Sensitivity analysis: missing data, Outcome 6 Occurrence of abnormal rScO2 during or after surgery: Desaturation: without missing data.

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Comparison 5 Sensitivity analysis: missing data, Outcome 7 Any major non‐neurological complications as defined by individual study: without missing data.
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Analysis 5.7

Comparison 5 Sensitivity analysis: missing data, Outcome 7 Any major non‐neurological complications as defined by individual study: without missing data.

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Comparison 6 Sensitivity analysis: reporting bias, Outcome 1 Any major non‐neurological complications as defined by individual study: including studies with reporting bias.
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Analysis 6.1

Comparison 6 Sensitivity analysis: reporting bias, Outcome 1 Any major non‐neurological complications as defined by individual study: including studies with reporting bias.

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Comparison 6 Sensitivity analysis: reporting bias, Outcome 2 Any major non‐neurological complications as defined by individual study: including studies without reporting bias.
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Analysis 6.2

Comparison 6 Sensitivity analysis: reporting bias, Outcome 2 Any major non‐neurological complications as defined by individual study: including studies without reporting bias.

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Comparison 7 Sensitivity analysis: other bias, Outcome 1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies with other bias.
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Analysis 7.1

Comparison 7 Sensitivity analysis: other bias, Outcome 1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies with other bias.

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Comparison 7 Sensitivity analysis: other bias, Outcome 2 POCD defined by original studies ‐ 1 week: including studies with other bias.
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Analysis 7.2

Comparison 7 Sensitivity analysis: other bias, Outcome 2 POCD defined by original studies ‐ 1 week: including studies with other bias.

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Comparison 7 Sensitivity analysis: other bias, Outcome 3 Intraoperative mortality or postoperative mortality: Death: including studies with other bias.
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Analysis 7.3

Comparison 7 Sensitivity analysis: other bias, Outcome 3 Intraoperative mortality or postoperative mortality: Death: including studies with other bias.

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Comparison 7 Sensitivity analysis: other bias, Outcome 4 The occurrence of abnormal rScO2 during or after surgery: Desaturation: including studies with other bias.
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Analysis 7.4

Comparison 7 Sensitivity analysis: other bias, Outcome 4 The occurrence of abnormal rScO2 during or after surgery: Desaturation: including studies with other bias.

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Comparison 7 Sensitivity analysis: other bias, Outcome 5 Any major non‐neurological complications as defined by individual study: including studies with other bias.
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Analysis 7.5

Comparison 7 Sensitivity analysis: other bias, Outcome 5 Any major non‐neurological complications as defined by individual study: including studies with other bias.

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Comparison 7 Sensitivity analysis: other bias, Outcome 6 Length of ICU stay (days): including studies with other bias.
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Analysis 7.6

Comparison 7 Sensitivity analysis: other bias, Outcome 6 Length of ICU stay (days): including studies with other bias.

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Comparison 7 Sensitivity analysis: other bias, Outcome 7 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies without other bias.
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Analysis 7.7

Comparison 7 Sensitivity analysis: other bias, Outcome 7 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies without other bias.

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Comparison 7 Sensitivity analysis: other bias, Outcome 8 The occurrence of abnormal rScO2 during or after surgery: Desaturation: including studies without other bias.
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Analysis 7.8

Comparison 7 Sensitivity analysis: other bias, Outcome 8 The occurrence of abnormal rScO2 during or after surgery: Desaturation: including studies without other bias.

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Comparison 7 Sensitivity analysis: other bias, Outcome 9 Any major non‐neurological complications as defined by individual study: including studies without other bias.
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Analysis 7.9

Comparison 7 Sensitivity analysis: other bias, Outcome 9 Any major non‐neurological complications as defined by individual study: including studies without other bias.

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Comparison 7 Sensitivity analysis: other bias, Outcome 10 Length of ICU stay (days): including studies without other bias.
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Analysis 7.10

Comparison 7 Sensitivity analysis: other bias, Outcome 10 Length of ICU stay (days): including studies without other bias.

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Summary of findings for the main comparison. Active cerebral oxygenation monitoring compared to blinded cerebral oxygenation monitoring for perioperative monitoring of brain oxygenation in children and adults

Active cerebral oxygenation monitoring compared to blinded cerebral oxygenation monitoring for perioperative monitoring of brain oxygenation in children and adults

Patient or population: children and adults undergoing surgery
Settings: hospitals (in Canada, United States, United Kingdom, Croatia, Australia, South Africa, Turkey, Poland and Greece) during the perioperative period (including in the operating room and ICU) and hospital stay
Intervention: active cerebral oxygenation monitoring
Comparison: blinded cerebral oxygenation monitoring

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Blinded cerebral oxygenation monitoring

Active cerebral oxygenation monitoring

Postoperative neurological injury

(follow‐up: 1 week or hospital discharge)

No pooled effect estimate available due to discordant direction of effect between studies. One study (N = 126) in people undergoing major abdominal surgery reported that 4/66 participants experienced neurological injury with blinded monitoring versus 0/56 in the active monitoring group. A second study (N = 195) in people having coronary artery bypass surgery reported that 1/96 participants experienced neurological injury in the blinded monitoring group compared with 4/94 participants in the active monitoring group.

Not estimable

312
(2 studies)

⊕⊕⊝⊝
low1,3

Very serious heterogeneity (I2 = 72%)

Postoperative stroke

(follow‐up: within 30 days)

40 per 1000

10 per 1000
(1 to 88)

RR 0.25
(0.03 to 2.20)

240
(2 studies)

⊕⊕⊝⊝
low1,2

—

POD: postoperative delirium

(follow‐up: 1 week)

135 per 1000

85 per 1000
(37 to 196)

RR 0.63
(0.27 to 1.45)

190
(1 study)

⊕⊕⊝⊝
low1,2

—

POCD defined by original studies ‐ mild

(follow‐up: 1 week)

641 per 1000

340 per 1000
(192 to 609)

RR 0.53
(0.30 to 0.95)

126
(2 studies)

⊕⊕⊝⊝
low1,2

—

POCD: decline in cognitive function

(follow‐up: 1 week)

400 per 1000

248 per 1000
(148 to 416)

RR 0.62
(0.37 to 1.04)

962
(6 studies)

⊕⊕⊕⊝
moderate1

—

Intraoperative mortality or postoperative mortality: Death

(follow‐up: 30 days)

10 per 1000

6 per 1000
(1 to 52)

RR 0.63
(0.08 to 5.03)

390
(3 studies)

⊕⊕⊝⊝
low1,2

—

Adverse events

See comments

See comments

Not estimable

See comments

See comments

None of the studies reported adverse effects caused by use of NIRS‐based cerebral oxygenation monitoring

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; POCD: postoperative cognitive dysfunction; POD: postoperative delirium; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Risk of bias: downgraded by one level because the body of evidence contained one or more of the following risks of bias: potential conflict of interest from industry sponsorship, unclear blinding status or missing participant data.
2Imprecision: downgraded by one level as the effect estimate included both appreciable benefit and appreciable harm, or the sample size is smaller than the optimal information size.
3Inconsistency: downgraded by one level as the statistical heterogeneity between studies was substantial.

Figuras y tablas -
Summary of findings for the main comparison. Active cerebral oxygenation monitoring compared to blinded cerebral oxygenation monitoring for perioperative monitoring of brain oxygenation in children and adults
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Table 1. Primary outcomes: single study forest plots and empty forest plots

1 Postoperative stroke or other neurological injury

1.1 Neurological injury

Active NIRS monitoring

Blinded NIRS monitoring

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Casati 2005

0

56

4

66

0.13 (0.01 to 2.37)

Colak 2015

4

94

1

96

4.09 (0.47 to 35.88)

1.2 Stroke

Cowie 2014

0

20

0

20

Not estimable

Murkin 2007

1

100

4

100

0.25 (0.03 to 2.20)

2 Postoperative stroke or other neurological injury: ASEM (endpoint score)

2.1 1 week

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Mean difference

Mean

SD

Total

Mean

SD

Total

Inverse variance, fixed‐effect model, 95% CI

Mohandas 2013

17.46

1.99

50

15.04

4.8

50

100.0%

2.42 (0.98 to 3.86)

Subtotal (95% CI)

50

50

100.0%

2.42 (0.98 to 3.86)

Test for overall effect: Z = 3.29 (P = 0.0010)

2.2 12 weeks

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Mean difference

Mean

SD

Total

Mean

SD

Total

Inverse variance, fixed‐effect model, 95% CI

Mohandas 2013

17.68

1.79

50

15.69

3.99

50

100.0%

1.99 (0.78 to 3.20)

Subtotal (95% CI)

50

50

100.0%

1.99 (0.78 to 3.20)

Test for overall effect: Z = 3.22 (P = 0.001)

3 Postoperative stroke or other neurological injury: Vigilance Reaction Time (change score)

3.1 1 week

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Mean difference

Mean

SD

Total

Mean

SD

Total

Inverse variance, fixed‐effect model, 95% CI

Ballard 2012

6.39

80.9

22

27.95

54.99

29

100.0%

‐21.56 (‐60.85 to 17.73)

Subtotal (95% CI)

22

29

100.0%

‐21.56 (‐60.85 to 17.73)

Test for overall effect: Z = 1.08 (P = 0.28)

3.2 12 weeks

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Mean difference

Mean

SD

Total

Mean

SD

Total

Inverse variance, fixed‐effect model, 95% CI

Ballard 2012

‐11.73

33.5

27

13.61

29.69

34

100.0%

‐25.34 (‐41.44 to ‐9.24)

Subtotal (95% CI)

27

34

100.0%

‐25.34 (‐41.44 to ‐9.24)

Test for overall effect: Z = 3.08 (P = 0.002)

3.3 52 weeks

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Mean difference

Mean

SD

Total

Mean

SD

Total

Inverse variance, fixed‐effect model, 95% CI

Ballard 2012

‐10.8

36.28

28

15.1

40.73

32

100.0%

‐25.90 (‐45.39 to ‐6.41)

Subtotal (95% CI)

28

32

100.0%

‐25.90 (‐45.39 to ‐6.41)

Test for overall effect: Z = 2.61 (P = 0.009)

4 Postoperative stroke or other neurological injury: Trail Making (change score)

4.1 12 weeks

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Mean difference

Mean

SD

Total

Mean

SD

Total

Inverse variance, fixed‐effect model, 95% CI

Ballard 2012

‐0.23

0.73

27

0.47

1.34

34

100.0%

‐0.70 (‐1.23 to ‐0.17)

Subtotal (95% CI)

27

34

100.0%

‐0.70 (‐1.23 to ‐0.17)

Test for overall effect: Z = 2.60 (P = 0.009)

4.2 52 weeks

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Mean difference

Mean

SD

Total

Mean

SD

Total

Inverse variance, fixed‐effect model, 95% CI

Ballard 2012

0.12

0.68

28

‐0.47

0.93

32

100.0%

0.59 (0.18 to 1.00)

Subtotal (95% CI)

28

32

100.0%

0.59 (0.18 to 1.00)

Test for overall effect: Z = 2.83 (P = 0.005)

5 POD: postoperative delirium

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Colak 2015

8

94

13

96

100.0%

0.63 (0.27 to 1.45)

Total (95% CI)

94

96

100.0%

0.63 (0.27 to 1.45)

Total events

8

13

Test for overall effect: Z = 1.09 (P = 0.27)

6 POCD as defined by the original studies ‐ 12 weeks

6.1 Mild

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Ballard 2012

13

24

27

33

100.0%

0.66 (0.44 to 0.99)

Subtotal (95% CI)

24

33

100.0%

0.66 (0.44 to 0.99)

Total events

13

27

Test for overall effect: Z = 2.01 (P = 0.04)

6.2 Moderate

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Ballard 2012

6

24

9

33

100.0%

0.92 (0.38 to 2.23)

Subtotal (95% CI)

24

33

100.0%

0.92 (0.38 to 2.23)

Total events

6

9

Test for overall effect: Z = 0.19 (P = 0.85)

6.3 Severe

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Ballard 2012

2

24

4

33

100.0%

0.69 (0.14 to 3.45)

Subtotal (95% CI)

24

33

100.0%

0.69 (0.14 to 3.45)

Total events

2

4

Test for overall effect: Z = 0.46 (P = 0.65)

7 POCD as defined by the original studies ‐ 52 weeks

7.1 Mild

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Ballard 2012

15

27

27

32

100.0%

0.66 (0.46 to 0.95)

Subtotal (95% CI)

27

32

100.0%

0.66 (0.46 to 0.95)

Total events

15

27

Test for overall effect: Z = 2.22 (P = 0.03)

7.2 Moderate

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Ballard 2012

3

27

12

32

100.0%

0.30 (0.09 to 0.94)

Subtotal (95% CI)

27

32

100.0%

0.30 (0.09 to 0.94)

Total events

3

12

Test for overall effect: Z = 2.06 (P = 0.04)

7.3 Severe

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Ballard 2012

1

27

4

32

100.0%

0.30 (0.04 to 2.49)

Subtotal (95% CI)

27

32

100.0%

0.30 (0.04 to 2.49)

Total events

1

4

Test for overall effect: Z = 1.12 (P = 0.26)

ASEM: antisaccadic eye movement test; CI: confidence interval; IQR: interquartile range; N: number; NIRS: near‐infrared spectroscopy; POCD: postoperative cognitive dysfunction; POD: postoperative delirium; S100B: one biomarker of cerebral damage; SD: standard deviation

Figuras y tablas -
Table 1. Primary outcomes: single study forest plots and empty forest plots
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Table 2. Secondary outcomes: single study forest plots and empty forest plots

1 The occurrence of abnormal rScO2 during or after surgery: desaturation time

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Mean difference

Mean

SD

Total

Mean

SD

Total

Inverse variance, fixed‐effect model, 95% CI

Harilall 2014

24.7

11.819

20

63.85

23.424

20

100.0%

‐39.15 (‐50.65 to ‐27.65)

Total (95% CI)

20

20

100.0%

‐39.15 (‐50.65 to ‐27.65)

Test for overall effect: Z = 6.67 ( P < 0.00001)

2 The occurrence of abnormal rScO2 during or after surgery: rScO2 below 50%

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Ballard 2012

1

30

6

35

100.0%

0.19 (0.02 to 1.53)

Total (95% CI)

30

35

100.0%

0.19 (0.02 to 1.53)

Total events

1

6

Test for overall effect: Z = 1.56 (P = 0.12)

3 Length of hospital stay (days)

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Mean difference

Mean

SD

Total

Mean

SD

Total

Inverse variance, fixed‐effect model, 95% CI

Kara 2015

7.15

1.39

43

7.67

1.14

36

100.0%

‐0.52 (‐1.08 to 0.04)

Total (95% CI)

43

36

100.0%

‐0.52 (‐1.08 to 0.04

Test for overall effect: Z = 1.83 (P = 0.07)

4 Length of hospital stay (days)

Study ID

Group

Mean

SD/95% CI

N

Cowie 2014

Intervention group

7.9

4.8 to 10.9

20

Control group

10.6

5.5 to 15.8

20

Deschamps 2013

Intervention group

7.6

5.4

23

Control group

7.9

3.2

25

Murkin 2007

Intervention group

6.1

4.4

100

Control group

6.9

5.5

100

Vretzakis 2013

Intervention group

10.9

3.6

75

Control group

10.2

10.7

75

CI: confidence interval; N: number; NIRS: near‐infrared spectroscopy; rScO2: regional cerebral oxygen saturation; SD: standard deviation

Figuras y tablas -
Table 2. Secondary outcomes: single study forest plots and empty forest plots
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Table 3. Sensitivity analysis: missing data ‐ single study forest plots and empty forest plots

1 Postoperative stroke or other neurological injury: including studies with missing data

1.1 Neurological injury

Active NIRS monitoring

Blinded NIRS monitoring

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Casati 2005

0

56

4

66

0.13 (0.01 to 2.37)

Colak 2015

4

94

1

96

4.09 (0.47 to 35.88)

1.2 Stroke

Cowie 2014

0

20

0

20

Not estimable

Murkin 2007

1

100

4

100

0.25 (0.03 to 2.20)

2 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies with missing data

2.1 52 weeks

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Mean difference

Mean

SD

Total

Mean

SD

Total

Inverse variance, fixed‐effect model, 95% CI

Ballard 2012

0.69

1.47

28

‐0.94

2.18

32

100.0%

1.63 (0.70 to 2.56)

Subtotal (95% CI)

28

32

100.0%

1.63 (0.70 to 2.56)

Test for overall effect: Z = 3.43 (P = 0.0006)

3 Postoperative stroke or other neurological injury: without missing data

3.1 Neurological injury

Active NIRS monitoring

Blinded NIRS monitoring

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Casati 2005

0

56

4

66

0.13 (0.01 to 2.37)

3.2 Stroke

Cowie 2014

0

20

0

20

Not estimable

Murkin 2007

1

100

4

100

0.25 (0.03 to 2.20)

4 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): without missing data

4.1 1 week

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Mean difference

Mean

SD

Total

Mean

SD

Total

Inverse variance, fixed‐effect model, 95% CI

Mohandas 2013

28.58

2.29

50

25.42

7.54

50

100.0%

3.16 (0.98 to 5.34)

Subtotal (95% CI)

50

50

100.0%

3.16 (0.98 to 5.34)

Test for overall effect: Z = 2.84 (P = 0.005)

65.2 12 weeks

Mohandas 2013

28.88

1.88

50

26.5

6.31

50

100.0%

2.38 (0.56 to 4.20)

Subtotal (95% CI)

50

50

100.0%

2.38 (0.56 to 4.20)

Test for overall effect: Z = 2.56 (P = 0.01)

CI: confidence interval; MMSE: mini‐mental state examination; NIRS: near‐infrared spectroscopy; SD: standard deviation

Figuras y tablas -
Table 3. Sensitivity analysis: missing data ‐ single study forest plots and empty forest plots
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Table 4. Sensitivity analysis: other bias ‐ single study forest plots

1 POCD defined by original studies ‐ 1 week: including studies without other bias

1.1 Mild

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Kara 2015

7

43

16

36

100.0%

0.37 (0.17 to 0.79)

Subtotal (95% CI)

43

36

100.0%

0.37 (0.17 to 0.79)

Total events

7

16

Heterogeneity: not applicable

Test for overall effect: Z = 2.56 (P = 0.01)

1.2 Severe

Kara 2015

0

43

3

36

100.0%

0.12 (0.01 to 2.25)

Subtotal (95% CI)

43

36

100.0%

0.12 (0.01 to 2.25)

Total events

0

3

Heterogeneity: not applicable

Test for overall effect: Z = 1.42 (P = 0.16)

2 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies without other bias

2.1 1 week

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Mean difference

Mean

SD

Total

Mean

SD

Total

Inverse variance, fixed‐effect model, 95% CI

Mohandas 2013

28.58

2.29

50

25.42

7.54

50

100.0%

3.16 (0.98 to 5.34)

Subtotal (95% CI)

50

50

100.0%

3.16 (0.98 to 5.34)

Test for overall effect: Z = 2.84 (P = 0.005)

3 Intraoperative mortality or postoperative mortality: death: including studies without other bias

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Vretzakis 2013

1

75

1

75

100.0%

1.00 (0.06 to 15.69)

Total (95% CI)

75

75

100.0%

1.00 (0.06 to 15.69)

Total events

1

1

Heterogeneity: not applicable

Test for overall effect: Z = 0.00 (P = 1.00)

4 The occurrence of abnormal rScO2 during or after surgery: desaturation: including studies without other bias

4.1 In ICU

Active NIRS monitoring

Blinded NIRS monitoring

Weight

Risk ratio

Events

Total

Events

Total

Mantel‐Haenszel, fixed‐effect model, 95% CI

Deschamps 2013

6

23

14

25

100.0%

0.47 (0.22 to 1.01)

Subtotal (95% CI)

23

25

100.0%

0.47 (0.22 to 1.01)

Total events

6

14

Heterogeneity: not applicable

Test for overall effect: Z = 1.94 (P = 0.05)

CI: confidence interval; ICU: intensive care unit; MMSE: mini‐mental state examination; NIRS: near‐infrared spectroscopy; POCD: postoperative cognitive dysfunction; SD: standard deviation; rScO2: regional cerebral oxygen saturation

Figuras y tablas -
Table 4. Sensitivity analysis: other bias ‐ single study forest plots
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Comparison 1. Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 1 week

2

151

Mean Difference (IV, Random, 95% CI)

2.72 [1.42, 4.03]

1.2 12 weeks

3

179

Mean Difference (IV, Random, 95% CI)

1.11 [0.15, 2.07]

1.3 52 weeks

1

60

Mean Difference (IV, Random, 95% CI)

1.63 [0.70, 2.56]

2 POCD defined by original studies ‐ 1 week Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Mild

2

126

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.30, 0.95]

2.2 Moderate

1

47

Risk Ratio (M‐H, Random, 95% CI)

0.46 [0.20, 1.04]

2.3 Severe

2

126

Risk Ratio (M‐H, Random, 95% CI)

0.18 [0.03, 0.92]

3 POCD: decline in cognitive function ‐ 1 week Show forest plot

6

962

Risk Ratio (M‐H, Random, 95% CI)

0.62 [0.37, 1.04]

4 Intraoperative mortality or postoperative mortality: Death Show forest plot

3

390

Risk Ratio (M‐H, Random, 95% CI)

0.63 [0.08, 5.03]

5 The occurrence of abnormal rScO2 during or after surgery: Desaturation Show forest plot

7

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 In OR

7

916

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.67, 0.99]

5.2 In ICU

2

249

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.37, 1.34]

6 Any major non‐neurological complications as defined by individual study Show forest plot

8

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

6.1 Non‐specific any reported complications

6

562

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.58, 1.00]

6.2 Non‐specific respiratory complications

1

122

Risk Ratio (M‐H, Random, 95% CI)

0.29 [0.03, 2.56]

6.3 Non‐specific cardiac complications

3

472

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.28, 2.31]

6.4 Non‐specific renal complications

2

230

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.27, 2.76]

6.5 Pneumothorax

1

150

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.01, 8.05]

6.6 Postoperative acute pulmonary edema

1

40

Risk Ratio (M‐H, Random, 95% CI)

0.2 [0.01, 3.92]

6.7 Postoperative pulmonary embolism

1

40

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.8 Prolonged mechanical ventilation

1

190

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.05, 5.54]

6.9 Arrhythmia

3

540

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.52, 1.34]

6.10 Myocardial infarction

4

580

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.35, 1.67]

6.11 Cardiac ischaemia

1

169

Risk Ratio (M‐H, Random, 95% CI)

0.26 [0.03, 2.27]

6.12 Cardiac arrest

2

190

Risk Ratio (M‐H, Random, 95% CI)

3.0 [0.12, 72.49]

6.13 Reoperation for bleeding

1

200

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.06, 15.77]

6.14 MOMM

1

200

Risk Ratio (M‐H, Random, 95% CI)

0.27 [0.08, 0.95]

6.15 Rupture of the colonic anastomosis

1

122

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.36, 2.83]

6.16 Surgical reintervention

1

200

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.01, 8.09]

6.17 Patients experiencing more than 1 complication

1

122

Risk Ratio (M‐H, Random, 95% CI)

0.29 [0.03, 2.56]

6.18 Wound infection

3

430

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.58, 1.60]

6.19 Revision

1

190

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.01, 8.25]

6.20 Hospital stay > 7 days (% of patients)

1

190

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.81, 1.48]

6.21 Mediastinitis

1

200

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.01, 8.09]

6.22 Septicaemia

1

200

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.01, 8.09]

6.23 Unplanned HDU/ICU admission

1

40

Risk Ratio (M‐H, Random, 95% CI)

0.5 [0.05, 5.08]

7 Length of ICU stay (days) Show forest plot

3

379

Mean Difference (IV, Random, 95% CI)

‐0.29 [‐0.48, ‐0.09]
Figuras y tablas -
Comparison 1. Active cerebral oxygenation monitoring vs blinded cerebral oxygenation monitoring
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Comparison 2. Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Postoperative stroke or other neurological injury: Neurological injury Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Cardiac or great vessel surgery

1

190

Risk Ratio (M‐H, Random, 95% CI)

4.09 [0.47, 35.88]

1.2 Other surgery

1

122

Risk Ratio (M‐H, Random, 95% CI)

0.13 [0.01, 2.37]

2 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 1 week Show forest plot

2

151

Mean Difference (IV, Random, 95% CI)

2.72 [1.42, 4.03]

2.1 Cardiac or great vessel surgery

1

100

Mean Difference (IV, Random, 95% CI)

3.16 [0.98, 5.34]

2.2 Other surgery

1

51

Mean Difference (IV, Random, 95% CI)

2.48 [0.85, 4.11]

3 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 12 weeks Show forest plot

3

179

Mean Difference (IV, Random, 95% CI)

1.11 [0.15, 2.07]

3.1 Cardiac or great vessel surgery

2

118

Mean Difference (IV, Random, 95% CI)

1.58 [‐0.10, 3.25]

3.2 Other surgery

1

61

Mean Difference (IV, Random, 95% CI)

0.75 [‐0.21, 1.71]

4 POCD defined by original studies ‐ 1 week ‐ mild Show forest plot

2

126

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.30, 0.95]

4.1 Cardiac or great vessel surgery

1

79

Risk Ratio (M‐H, Random, 95% CI)

0.37 [0.17, 0.79]

4.2 Other surgery

1

47

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.43, 0.97]

5 POCD defined by original studies ‐ 1 week ‐ severe Show forest plot

2

126

Risk Ratio (M‐H, Random, 95% CI)

0.18 [0.03, 0.92]

5.1 Cardiac or great vessel surgery

1

79

Risk Ratio (M‐H, Random, 95% CI)

0.12 [0.01, 2.25]

5.2 Other surgery

1

47

Risk Ratio (M‐H, Random, 95% CI)

0.21 [0.03, 1.58]

6 POCD: decline in cognitive function ‐ 1 week Show forest plot

6

962

Risk Ratio (M‐H, Random, 95% CI)

0.62 [0.37, 1.04]

6.1 Cardiac or great vessel surgery

4

671

Risk Ratio (M‐H, Random, 95% CI)

0.46 [0.19, 1.11]

6.2 Carotid endarterectomy

1

169

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.42, 2.10]

6.3 Other surgery

1

122

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.51, 1.22]
Figuras y tablas -
Comparison 2. Subgroup of participants: participants with carotid endarterectomy, cardiac or great vessel surgery, or other surgery
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Comparison 3. Subgroup of interventions: cerebral oxygenation monitoring (EQUANOX) or INVOS vs blinded monitoring

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 1 week Show forest plot

2

151

Mean Difference (IV, Random, 95% CI)

2.72 [1.42, 4.03]

1.1 INVOS

1

51

Mean Difference (IV, Random, 95% CI)

2.48 [0.85, 4.11]

1.2 EQUANOX

1

100

Mean Difference (IV, Random, 95% CI)

3.16 [0.98, 5.34]

2 Postoperative stroke or other neurological injury: MMSE (endpoint or change score) ‐ 12 weeks Show forest plot

3

179

Mean Difference (IV, Random, 95% CI)

1.11 [0.15, 2.07]

2.1 INVOS

2

79

Mean Difference (IV, Random, 95% CI)

0.73 [‐0.13, 1.60]

2.2 EQUANOX

1

100

Mean Difference (IV, Random, 95% CI)

2.38 [0.56, 4.20]

3 POCD: decline in cognitive function ‐ 1 week Show forest plot

6

962

Risk Ratio (M‐H, Random, 95% CI)

0.62 [0.37, 1.04]

3.1 INVOS

5

862

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.61, 1.04]

3.2 EQUANOX

1

100

Risk Ratio (M‐H, Random, 95% CI)

0.06 [0.01, 0.23]
Figuras y tablas -
Comparison 3. Subgroup of interventions: cerebral oxygenation monitoring (EQUANOX) or INVOS vs blinded monitoring
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Comparison 4. Sensitivity analysis: detection bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any major non‐neurological complications as defined by individual study: including studies with detection bias Show forest plot

7

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Non‐specific any reported complications

6

562

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.58, 1.00]

1.2 Non‐specific cardiac complications

3

472

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.28, 2.31]

1.3 Non‐specific renal complications

2

230

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.27, 2.76]

1.4 Arrhythmia

3

540

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.52, 1.34]

1.5 Myocardial infarction

4

580

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.35, 1.67]

1.6 Cardiac arrest

2

190

Risk Ratio (M‐H, Random, 95% CI)

3.0 [0.12, 72.49]

1.7 Wound infection

3

430

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.58, 1.60]

2 Any major non‐neurological complications as defined by individual study: including studies without detection bias Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Non‐specific any reported complications

5

537

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.57, 0.99]

2.2 Non‐specific cardiac complications

3

472

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.28, 2.31]

2.3 Non‐specific renal complications

2

230

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.27, 2.76]

2.4 Arrhythmia

3

540

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.52, 1.34]

2.5 Myocardial infarction

4

580

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.35, 1.67]

2.6 Cardiac arrest

2

190

Risk Ratio (M‐H, Random, 95% CI)

3.0 [0.12, 72.49]

2.7 Wound infection

3

430

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.58, 1.60]
Figuras y tablas -
Comparison 4. Sensitivity analysis: detection bias
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Comparison 5. Sensitivity analysis: missing data

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies with missing data Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 1 week

2

151

Mean Difference (IV, Random, 95% CI)

2.72 [1.42, 4.03]

1.2 12 weeks

3

179

Mean Difference (IV, Random, 95% CI)

1.11 [0.15, 2.07]

2 POCD: decline in cognitive function ‐ 1 week: including studies with missing data Show forest plot

6

962

Risk Ratio (M‐H, Random, 95% CI)

0.62 [0.37, 1.04]

3 Occurrence of abnormal rScO2 during or after surgery: Desaturation: including studies with missing data Show forest plot

7

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 In OR

7

916

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.67, 0.99]

3.2 In ICU

2

249

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.37, 1.34]

4 Any major non‐neurological complications as defined by individual study: including studies with missing data Show forest plot

7

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Non‐specific any reported complications

6

562

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.58, 1.00]

4.2 Non‐specific respiratory complications

1

122

Risk Ratio (M‐H, Random, 95% CI)

0.29 [0.03, 2.56]

4.3 Non‐specific renal complications

2

230

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.27, 2.76]

4.4 Non‐specific cardiac complications

3

472

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.28, 2.31]

4.5 Arrhythmia

3

540

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.52, 1.34]

4.6 Myocardial infarction

4

580

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.35, 1.67]

4.7 Wound infection

3

430

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.58, 1.60]

5 POCD: decline in cognitive function ‐ 1 week: without missing data Show forest plot

5

781

Risk Ratio (M‐H, Random, 95% CI)

0.62 [0.31, 1.21]

6 Occurrence of abnormal rScO2 during or after surgery: Desaturation: without missing data Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

6.1 In OR

6

851

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.67, 0.99]

6.2 In ICU

2

249

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.37, 1.34]

7 Any major non‐neurological complications as defined by individual study: without missing data Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

7.1 Non‐specific any reported complications

5

537

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.57, 0.99]

7.2 Non‐specific respiratory complications

1

40

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.29, 3.45]

7.3 Arrhythmia

2

350

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.13, 5.12]

7.4 Myocardial infarction

3

390

Risk Ratio (M‐H, Random, 95% CI)

0.48 [0.13, 1.70]

7.5 Wound infection

2

240

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.38, 2.48]
Figuras y tablas -
Comparison 5. Sensitivity analysis: missing data
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Comparison 6. Sensitivity analysis: reporting bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any major non‐neurological complications as defined by individual study: including studies with reporting bias Show forest plot

7

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Non‐specific any reported complications

6

562

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.58, 1.00]

1.2 Non‐specific cardiac complications

3

472

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.28, 2.31]

1.3 Non‐specific renal complications

2

230

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.27, 2.76]

1.4 Arrhythmia

3

540

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.52, 1.34]

1.5 Myocardial infarction

4

580

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.35, 1.67]

1.6 Cardiac arrest

2

190

Risk Ratio (M‐H, Random, 95% CI)

3.0 [0.12, 72.49]

1.7 Wound infection

3

430

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.58, 1.60]

2 Any major non‐neurological complications as defined by individual study: including studies without reporting bias Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Non‐specific any reported complications

5

537

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.57, 0.99]

2.2 Non‐specific cardiac complications

3

472

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.28, 2.31]

2.3 Non‐specific renal complications

2

230

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.27, 2.76]

2.4 Arrhythmia

3

540

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.52, 1.34]

2.5 Myocardial infarction

4

580

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.35, 1.67]

2.6 Cardiac arrest

2

190

Risk Ratio (M‐H, Random, 95% CI)

3.0 [0.12, 72.49]

2.7 Wound infection

3

430

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.58, 1.60]
Figuras y tablas -
Comparison 6. Sensitivity analysis: reporting bias
Ir a la tabla de la revisión
Comparison 7. Sensitivity analysis: other bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies with other bias Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 1 week

2

151

Mean Difference (IV, Random, 95% CI)

2.72 [1.42, 4.03]

1.2 12 weeks

3

179

Mean Difference (IV, Random, 95% CI)

1.11 [0.15, 2.07]

2 POCD defined by original studies ‐ 1 week: including studies with other bias Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Mild

2

126

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.30, 0.95]

2.2 Severe

2

126

Risk Ratio (M‐H, Random, 95% CI)

0.18 [0.03, 0.92]

3 Intraoperative mortality or postoperative mortality: Death: including studies with other bias Show forest plot

3

390

Risk Ratio (M‐H, Random, 95% CI)

0.63 [0.08, 5.03]

4 The occurrence of abnormal rScO2 during or after surgery: Desaturation: including studies with other bias Show forest plot

7

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 In OR

7

916

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.67, 0.99]

4.2 In ICU

2

249

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.37, 1.34]

5 Any major non‐neurological complications as defined by individual study: including studies with other bias Show forest plot

7

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 Non‐specific any reported complications

6

562

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.58, 1.00]

5.2 Non‐specific cardiac complications

3

472

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.28, 2.31]

5.3 Non‐specific renal complications

2

230

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.27, 2.76]

5.4 Arrhythmia

3

540

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.52, 1.34]

5.5 Myocardial infarction

4

580

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.35, 1.67]

5.6 Cardiac arrest

2

190

Risk Ratio (M‐H, Random, 95% CI)

3.0 [0.12, 72.49]

5.7 Wound infection

3

430

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.58, 1.60]

6 Length of ICU stay (days): including studies with other bias Show forest plot

3

379

Mean Difference (IV, Random, 95% CI)

‐0.29 [‐0.48, ‐0.09]

7 Postoperative stroke or other neurological injury: MMSE (endpoint or change score): including studies without other bias Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

7.1 12 weeks

2

118

Mean Difference (IV, Random, 95% CI)

1.58 [‐0.10, 3.25]

8 The occurrence of abnormal rScO2 during or after surgery: Desaturation: including studies without other bias Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

8.1 In OR

3

410

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.69, 1.13]

9 Any major non‐neurological complications as defined by individual study: including studies without other bias Show forest plot

5

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

9.1 Non‐specific any reported complications

4

322

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.57, 1.68]

9.2 Non‐specific cardiac complications

2

272

Risk Ratio (M‐H, Random, 95% CI)

1.20 [0.42, 3.44]

9.3 Non‐specific renal complications

1

190

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.01, 8.25]

9.4 Arrhythmia

2

340

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.53, 1.39]

9.5 Myocardial infarction

2

340

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.38, 2.20]

9.6 Cardiac arrest

1

150

Risk Ratio (M‐H, Random, 95% CI)

3.0 [0.12, 72.49]

9.7 Wound infection

1

190

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.53, 1.76]

10 Length of ICU stay (days): including studies without other bias Show forest plot

2

179

Mean Difference (IV, Random, 95% CI)

‐0.23 [‐0.39, ‐0.07]
Figuras y tablas -
Comparison 7. Sensitivity analysis: other bias
Ir a la tabla de la revisión