This meta-analysis included 17 randomized trials involving 2288 adults undergoing on-pump cardiac surgery, comparing intraoperative NIRS-guided management with usual care. NIRS guidance probably reduced early postoperative cognitive decline (RR 0.65, 95% CI 0.42–0.99; moderate-certainty evidence). Effects on stroke (RR 0.89, 95% CI 0.42–1.91), mortality (RR 0.84, 95% CI 0.47–1.52), and delirium (RR 0.78, 95% CI 0.56–1.09) remained uncertain, with low-certainty evidence. Trials were predominantly small and single-centre, with heterogeneous thresholds and intervention algorithms. Few assessed outcomes beyond 30 days; none assessed validated quality-of-life or functional measures.
NIRS-guided intraoperative care may reduce early cognitive decline after on-pump cardiac surgery, but benefits for mortality, stroke, delirium, and longer-term recovery remain unestablished.
Study limitation: Predominantly small, single-centre trials used heterogeneous NIRS protocols, and evidence on longer-term patient-centred outcomes was sparse.
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