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

BACKGROUND

Postoperative delirium (POD) is a common complication following surgery, associated with extended hospital stays, cognitive decline, and increased mortality, yet effective pharmacological prevention remains elusive. Processed electroencephalography (p-EEG) guided general anesthesia is designed to reduce excessive neural suppression linked to POD development. However, conflicting evidence exists due to variations in devices and regional practices.

METHODS

We systematically searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from database inception to January 2025, randomized controlled trial (RCT) comparing p-EEG guided general anesthesia with standard care in adult surgical patients. Statistical analysis employed random-effects models calculated risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CIs). The primary outcome was POD incidence.

RESULTS

Twelve RCTs involving 4523 surgical patients were included. p-EEG guided general anesthesia reduced the incidence of POD compared with control group (RR 0.81, 95% CI 0.69-0.95, I2 = 46%), with pronounced benefits in elderly patients (≥60 years, RR 0.83, 95% CI 0.69-0.99) and non-cardiac surgeries (RR 0.78, 95% CI 0.64-0.95). Regional heterogeneity was significant: European and East Asian/Australasian trials demonstrated efficacy, whereas North American studies showed no benefit. In addition, p-EEG guided general anesthesia reduced postoperative cognitive dysfunction (RR 0.66, 95% CI 0.49-0.89), shortened hospital stays (MD -0.90 days, 95% CI -1.60 to -0.20), and lowered vasopressor requirements (RR 0.73, 95% CI 0.64-0.83). Mortality did not differ between groups.

CONCLUSION

p-EEG guided general anesthesia demonstrates reduces POD incidence and associated complications, especially in elderly patients and non-cardiac surgeries. However, the effectiveness may vary due to differences in practice, anesthetic protocols, and cultural factors. Our findings support the implementation of tailored neuromonitoring in high-risk populations.