Abstract
OBJECTIVE: To systematically evaluate the impact of ciprofol on the incidence of postoperative delirium (POD) in adult surgical patients and to explore potential sources of heterogeneity. METHODS: A systematic search was conducted in databases including PubMed, Web of Science, OVID, EMBASE, and the Cochrane Library to identify clinical studies published before October 2025 comparing ciprofol vs. propofol for general anesthesia. The Newcastle-Ottawa Scale was employed to assess study quality. Meta-analysis and meta-regression were performed using R software to calculate the POD incidence and its 95% confidence interval (CI). Subgroup analysis and sensitivity analysis were conducted to explore sources of heterogeneity. RESULTS: Seven studies involving 4,171 patients were included. The overall POD incidence in the ciprofol group was 11.30% (95% CI: 0.77%-21.83%), which was significantly lower than that in the propofol group (19.51%; 95% CI: 2.51%-36.50%). Subgroup analysis revealed that the advantage of ciprofol in reducing POD incidence was more pronounced in patients undergoing trunk surgery (19.29% vs. 0.56%) and in those receiving total intravenous anesthesia (2.93% vs. 14.33%). Meta-regression did not identify significant correlations between POD incidence and age, sex distribution, or intraoperative hypotension. Significant heterogeneity was observed across studies (I (2) > 85%), but sensitivity analysis confirmed the robustness of the results. CONCLUSION: Compared with propofol, ciprofol significantly reduces the risk of POD in surgical patients, with particularly pronounced benefits in those undergoing trunk surgery and receiving total intravenous anesthesia. These findings provide new evidence for perioperative neurocognitive protection. SYSTEMATIC REVIEW REGISTRATION: INPLASY International Platform, registration number: INPLASY202610019, DOI: 10.37766/inplasy2026.1.0019.