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

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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.

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