Effect of Family Intervention on Postoperative Delirium in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

BACKGROUND: Postoperative delirium (POD) is a common and serious complication after cardiac surgery. Although family involvement is considered a promising nonpharmacological strategy, its efficacy specifically in patients undergoing cardiac surgery remains inadequately supported by systematic evidence. OBJECTIVE: Our aim was to evaluate the effectiveness of family interventions in preventing POD among patients undergoing cardiac surgery. METHODS: We systematically searched multiple databases from inception to July 2025 for randomized controlled trials (RCTs) assessing family intervention for POD in patients undergoing cardiac surgery. Study selection, quality assessment, and data extraction were performed independently by 2 reviewers. We conducted a meta-analysis using RevMan 5.4 and Stata 18.0, with effects expressed as risk ratios or standard mean differences and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to evaluate evidence quality. The protocol was registered on PROSPERO (CRD42024627097). RESULTS: A total of 6 RCTs with 508 patients were included in the analysis. Family intervention significantly reduced the incidence of POD (risk ratio = 0.38, 95% CI: 0.25-0.58, P < .001) and shortened hospital length of stay (standard mean difference = -1.07, 95% CI: -1.91 to -0.24, P < .05). Our subgroup analysis revealed no significant differences in outcomes based on family involvement level, age, or sample size. Additionally, interventions improved psychological well-being and increased caregiver satisfaction ( P < .05). CONCLUSIONS: Family intervention reduces POD incidence and hospital stay and enhances psychological outcomes for patients and caregivers. However, due to small sample sizes, further large-scale high-quality RCTs are warranted.