Transcutaneous electrical acupoint stimulation for preventing postoperative delirium in elderly patients: a systematic review and meta-analysis

Objective: To systematically evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) in preventing postoperative delirium (POD) in elderly patients undergoing various surgical procedures. Methods: A comprehensive literature search was conducted across multiple electronic databases to identify randomized controlled trials (RCTs) comparing TEAS with control interventions (sham or no stimulation) in patients aged >60 years undergoing surgery. The primary outcome was the incidence of POD within the first seven postoperative days. Meta-analysis was performed using RevMan software, calculating risk ratios (RR), mean differences (MD), or standard MD with 95% confidence intervals (CIs). The quality of evidence was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Twenty RCTs involving 2,290 patients (aged >60 years) were included. The overall incidence of POD was 5.6% in the TEAS group compared to 17.0% in the control group (RR 0.34, 95% CI 0.26-0.45). TEAS also significantly reduced CAM score (MD -1.01, 95% CI -1.98 to -0.04), propofol consumption (MD -35.59 mg, 95% CI -65.75 to -5.42), postoperative pain score (MD -0.60, 95% CI -1.02 to -0.18), and improved recovery quality (QoR-15 score: MD 23.76, 95% CI 21.72-25.80). The intervention appeared safe with no serious adverse events reported. Conclusion: Perioperative TEAS application significantly reduces the risk of POD in elderly surgical patients. Its protective effects are potentially mediated through anti-inflammatory effects. TEAS represents a promising non-pharmacological intervention for POD prevention within enhanced recovery protocols. Systematic review registration: CRD420251128976.