Efficacy and safety of perioperative melatonin for postoperative delirium in patients undergoing surgery: a systematic review and meta-analysis

• Published in: Journal of international medical research 2024-05, Vol.52 (5), p.3000605241239854-3000605241239854
• Main Authors: Shin, Hye Won, Kwak, Ji Su, Choi, Yoon Ji, Kim, Jae Woo, You, Hae Sun, Shin, Hyun Ju, Jang, Yoo Kyung
• Format: Article
• Language: English
• Subjects: Delirium; Delirium - drug therapy; Delirium - prevention & control; Hospital Mortality; Humans; Indenes - administration & dosage; Indenes - adverse effects; Indenes - therapeutic use; Length of Stay; Melatonin; Melatonin - administration & dosage; Melatonin - adverse effects; Melatonin - therapeutic use; Meta-Analysis and Systematic Review; Perioperative Care - methods; Postoperative Complications - drug therapy; Postoperative Complications - prevention & control; Postoperative period; Randomized Controlled Trials as Topic; Surgery; Treatment Outcome
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/03000605241239854

Objective To assess the efficacy and safety of perioperative melatonin and melatonin agonists in preventing postoperative delirium (POD). Methods We conducted a systematic search for randomized controlled trials (RCTs) published through December 2022. The primary outcome was efficacy based on the incidence of POD (POD-I). Secondary outcomes included efficacy and safety according to the length of hospital or intensive care unit stay, in-hospital mortality, and adverse events. Subgroup analyses of POD-I were based on the type and dose of drug (low- and high-dose melatonin, ramelteon), the postoperative period (early or late), and the type of surgery. Results In the analysis (16 RCTs, 1981 patients), POD-I was lower in the treatment group than in the control group (risk ratio [RR] = 0.57). POD-I was lower in the high-dose melatonin group than in the control group (RR = 0.41), whereas no benefit was observed in the low-dose melatonin and ramelteon groups. POD-I was lower in the melatonin group in the early postoperative period (RR = 0.35) and in patients undergoing cardiopulmonary surgery (RR = 0.54). Conclusion Perioperative melatonin or melatonin agonist treatment suppressed POD without severe adverse events, particularly at higher doses, during the early postoperative period, and after cardiopulmonary surgery.