Comparing the effects of propofol and sevoflurane anesthesia on cognitive dysfunction in elderly patients after abdominal surgery: a systematic review and meta-analysis of randomised controlled trials

Objectives: To conduct a systematic review and comparison of the effects of propofol and sevoflurane anesthesia on cognitive dysfunction in elderly patients following abdominal surgery. Methods: Comparative studies published in PubMed, Web of Science, EBSCOhost, Cochrane Library, EMBASE, and Medline databases as of 08 Jun 2025 were searched. The final extracted data was analyzed using Review Manager 5.4. Results: The 7 randomized controlled studies included a total of 802 patients who had undergone abdominal surgery, of whom 402 were anesthetized with propofol and 400 were anesthetized with sevoflurane. The outcomes of the meta-analysis showed that there were no statistically significant differences in operating time, anesthesia time, incidence of hypotension, the incidence of postoperative cognitive dysfunction (all P > 0.05), between the propofol and sevoflurane groups. Moreover, there was no significant difference in the severity of cognitive dysfunction between the two groups of patients on the 1st, 3rd, and 7th day after surgery (all P > 0.05). Conclusion: The meta-analysis results showed that there was no significant difference in the severity of cognitive dysfunction between the he propofol and sevoflurane groups of patients on the 1st, 3rd, and 7th day after surgery. This conclusion still does not prove that either one is more suitable for anesthesia in elderly patients, and more samples and clinical studies are needed to confirm. Trial Registration: PROSPERO registration number is: CRD42022324055.