Effect of processed electroencephalography-guided anesthesia on postoperative delirium: an updated systematic review and meta-analysis.

Summary

Across 12 RCTs (n=4523), processed EEG–guided anesthesia reduced postoperative delirium (RR 0.81) with stronger effects in older patients and non-cardiac surgeries, and also reduced postoperative cognitive dysfunction, length of stay, and vasopressor use. Benefits varied geographically, with no mortality difference.

Key Findings

• Processed EEG–guided anesthesia reduced postoperative delirium versus standard care (RR 0.81, 95% CI 0.69–0.95; I2=46%).
• Greater benefit in elderly (≥60 years; RR 0.83) and non-cardiac surgeries (RR 0.78).
• Reduced postoperative cognitive dysfunction (RR 0.66), hospital length of stay (MD −0.90 days), and vasopressor requirements (RR 0.73); mortality unchanged.

Clinical Implications

Adopt processed-EEG guidance for high-risk patients (older adults, non-cardiac surgeries) to minimize burst suppression and deep anesthesia, with attention to device/protocol standardization and regional practice patterns.

Limitations

• Considerable heterogeneity across devices, protocols, and regions; I2 up to 46%
• Regional null findings (North America) limit generalizability; mortality unaffected

Future Directions

Standardize EEG targets (e.g., burst suppression thresholds), harmonize devices/protocols, and conduct pragmatic implementation trials focusing on delirium prevention bundles.