Perioperative neurocognitive outcomes after robot-assisted pelvic surgery: a systematic review and meta-analysis of reported proportions, comparative risk and prognostic factors.
Rafał Bogdan Drobot, Jędrzej Jakub Skorupka, Marcin Lipa
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In 30 seconds
This systematic review and meta-analysis examined delirium and cognitive decline after robot-assisted pelvic surgery in adults, including reported proportions, comparative risk, and prognostic factors. Twenty-six reports represented 25 studies. Across five prospective cognitive cohorts (356 participants), the pooled proportion with cognitive decline was 29.0% (95% confidence interval [CI] 20.2-39.8%). Three delirium cohorts (245 participants) produced a descriptive summary of 10.3% (2.2-37.0%), with substantial uncertainty. The same-procedure prostatectomy comparison found an unadjusted risk ratio of 1.06 (0.73-1.55) for early cognitive decline. Comparative evidence was low or very low certainty.
Key findings
- Five cognitive cohorts (356 participants) yielded a pooled cognitive-decline proportion of 29.0% (95% CI 20.2-39.8%).
- Three delirium cohorts (245 participants) yielded a descriptive summary of 10.3% (2.2-37.0%); the approximate 95% prediction interval was <0.1-99.8%.
- In the same-procedure prostatectomy comparison, the unadjusted risk ratio for early cognitive decline was 1.06 (0.73-1.55).
- Findings on Trendelenburg duration were inconsistent, and comparative evidence was of low or very low certainty.
Why it matters
The review indicates that study-defined cognitive decline and delirium are reported after robot-assisted pelvic surgery, but estimates vary and do not establish how much risk is attributable to robotic surgery or positioning. Differences in outcome definitions, surveillance, and patient selection constrain interpretation. These uncertainties matter when discussing perioperative cognitive outcomes and highlight the need for consistent prospective measurement.
What to keep in mind
Definitions, surveillance, and selection limited interpretation; the delirium estimate was highly imprecise, with a very wide prediction interval. Comparative evidence was low or very low certainty.