Orthopedic Surgery

Dexmedetomidine most consistently reduces postoperative delirium after elderly orthopaedic surgery

This Bayesian network meta-analysis of 79 RCTs (16,012 patients) evaluated perioperative interventions to prevent postoperative delirium in adults ≥60 undergoing orthopaedic surgery. Compared with placebo, dexmedetomidine reduced POD incidence with RR 0.49 (95% CrI 0.39–0.61). Ketamine, rivastigmine, olanzapine, and lidocaine showed heterogeneous, sometimes promising effects requiring confirmation. The authors note limited evidence for specific analgesic or anaesthetic regimens and call for high-quality confirmatory RCTs. 1

Protocol to quantify attrition timing and risk factors in hand and wrist trauma RCTs

This protocol plans a systematic review and meta-analysis of attrition in hand and wrist trauma RCTs at 30, 90 days, 6 months, and 12 months. The objective is to quantify attrition rates and identify demographic, intervention, and injury predictors of loss to follow-up. Risk-of-bias will be assessed with Cochrane RoB 2 and findings intend to inform tools to improve follow-up and study design. Results will apply to trialists and clinicians interpreting hand/wrist RCTs, but no primary data are yet presented. 2

Adaptive platform protocol to evaluate AI tools within Cochrane review workflows (CESAR)

The CESAR protocol describes an adaptive SWAR platform comparing AI-assisted versus human-only workflows across screening and data extraction tasks. Performance metrics include accuracy (sensitivity, specificity), time-on-task, error impact, and usability aligned with RAISE principles. The adaptive design allows adding or dropping AI tools based on interim results without restarting the study. This is a methods protocol; it outlines evaluation structure but provides no empirical performance data yet. 3