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To examine the effect of bispectral index (BIS)-guided anesthesia on the incidence of postoperative delirium (POD) in elderly patients undergoing surgery. A systematic review, meta-analysis, and trial sequential analysis (TSA). In the operating room, postoperative anesthesia care units (PACU), and ward. Elderly patients (60 years old) undergoing surgery. The EMBASE, MEDLINE, and CENTRAL databases were searched systematically from their inception until December 2020 for randomized controlled trials comparing BIS and usual care or blin