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. 2024 May 13:16:1386669.
doi: 10.3389/fnagi.2024.1386669. eCollection 2024.

Intraoperative electroencephalogram patterns as predictors of postoperative delirium in older patients: a systematic review and meta-analysis

Valery V Likhvantsev  1   2 , Levan B Berikashvili  1 , Anastasia V Smirnova  1 , Petr A Polyakov  1 , Mikhail Ya Yadgarov  1 , Nadezhda D Gracheva  1 , Olga E Romanova  1 , Irina S Abramova  3 , Maria M Shemetova  1 , Artem N Kuzovlev  1
Affiliations

Intraoperative electroencephalogram patterns as predictors of postoperative delirium in older patients: a systematic review and meta-analysis

Valery V Likhvantsev et al. Front Aging Neurosci. .

Abstract

Background: Postoperative delirium (POD) significantly affects patient outcomes after surgery, leading to increased morbidity, extended hospital stays, and potential long-term cognitive decline. This study assessed the predictive value of intraoperative electroencephalography (EEG) patterns for POD in adults.

Methods: This systematic review and meta-analysis followed the PRISMA and Cochrane Handbook guidelines. A thorough literature search was conducted using PubMed, Medline, and CENTRAL databases focusing on intraoperative native EEG signal analysis in adult patients. The primary outcome was the relationship between the burst suppression EEG pattern and POD development.

Results: From the initial 435 articles identified, 19 studies with a total of 7,229 patients were included in the systematic review, with 10 included in the meta-analysis (3,705 patients). In patients exhibiting burst suppression, the POD incidence was 22.1% vs. 13.4% in those without this EEG pattern (p=0.015). Furthermore, an extended burst suppression duration associated with a higher likelihood of POD occurrence (p = 0.016). Interestingly, the burst suppression ratio showed no significant association with POD.

Conclusions: This study revealed a 41% increase in the relative risk of developing POD in cases where a burst suppression pattern was present. These results underscore the clinical relevance of intraoperative EEG monitoring in predicting POD in older patients, suggesting its potential role in preventive strategies.

Systematic review registration: This study was registered on International Platform for Registered Protocols for Systematic Reviews and Meta-Analyses: INPLASY202420001, https://doi.org/10.37766/inplasy2024.2.0001.

Keywords: anesthesia; burst suppression; intraoperative EEG; meta-analysis; postoperative delirium; surgery; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram for study selection.
Figure 2
Figure 2
Forest plot for burst suppression incidence by POD type. The plot displays the studies, sample sizes, odds ratios, confidence intervals (CIs), and p-values. The size of the squares indicates the weight of the studies (considering sample size and standard deviations); the diamond represents the pooled odds ratio with CIs.
Figure 3
Figure 3
SROC for the presence of burst suppression. The plot displays the summary ROC curve (SROC) and presents AUC with 95% confidence interval (CI), 95% prediction and confidence contours, sensitivity, and specificity with CIs.
See this image and copyright information in PMC

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