1242 - Bridging Surgery and Rehab: A Meta-Analysis of Perioperative Dexmedetomidine for Delirium Reduction and Functional Recovery in Older Adults

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

MS

Mansoor Sadath, BS

Medical Student
Rowan School of Osteopathic Medicine
Bayonne, New Jersey, United States
SA

Sami Asif, MBS, BS

Medical Student
Rowan University School of Osteopathic
North Brunswick, New Jersey, United States
NU

Nafee Ullah, MD

Resident Physician
Hackensack Meridian School of Medicine
Bayonne, New Jersey, United States
GS

Gaurav Sahgal, BS

Medical Student
Rowan University School of Osteopathic Medicine
Glassboro, New Jersey, United States

Submitter(s)

MS

Mansoor Sadath

Rowan School of Osteopathic Medicine
Bayonne, New Jersey, United States

Objectives: To evaluate the effect of perioperative dexmedetomidine on early rehabilitation engagement and functional recovery while assessing rates of postoperative delirium, cognitive outcomes and pain control, among older adults undergoing major orthopedic and spinal surgery.

Design: A search using prespecified criteria was conducted on PubMed, Embase, Scopus, and Cochrane databases for literature published between August 2015 and August 2025. Thirty-one randomized controlled trials comparing dexmedetomidine versus standard care or alternative sedatives in adults ≥60 years were included. Primary outcomes included delirium incidence, postoperative cognitive dysfunction, pain scores, and rehabilitation participation. Delirium and cognition were evaluated using the Confusion Assessment Method (CAM), Nursing Delirium Screening Scale (Nu-DESC), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). Sleep and pain were assessed using patient-reported outcome tools. Risk of bias was assessed using the Cochrane tool, and heterogeneity of studies was assessed using the I² statistic.

Results: Dexmedetomidine significantly reduced postoperative delirium with a risk ratio of 0.58 (95% CI: 0.49 to 0.67) and POCD with a risk ratio of 0.59 (95% CI: 0.38 to 0.96). Sleep quality was found to be improved, and pain scores were consistently observed to be lower. The reduced rates of delirium and cognitive dysfunction were associated with increased participation in early rehabilitation, supporting improved recovery. Adverse events included increased bradycardia and hypotension; however, no statistically significant increase in mortality or morbidity was reported.

Conclusions: Perioperative dexmedetomidine is associated with reduced delirium and short-term cognitive dysfunction in older adults while improving pain control and sleep. These benefits may facilitate early mobilization and engagement in rehabilitation, but the risk of hypotension and bradycardia must be evaluated to ensure optimal patient care. The use of dexmedetomidine is a potential bridge between surgical care and rehabilitation, aligning anesthetic strategies with physiatric goals to optimize functional recovery.