Effect of electroencephalogram-guided anesthesia on postoperative delirium in older adults after surgery: a systematic review and meta-analysis

Abstract

Background: Postoperative delirium is a frequent and severe complication among elderly surgical patients. Electroencephalogram (EEG)-guided anesthesia, which optimizes sedation depth, holds promise for preventing postoperative delirium; however, current research findings remain inconsistent. This meta-analysis incorporates the most recent trials to evaluate the effectiveness of EEG-guided anesthesia in reducing postoperative delirium incidence in older adults. Methods: We conducted a comprehensive literature search of PubMed, the Cochrane Central Register of Controlled Trials, and Embase from their inception to February 1, 2025, to identify eligible studies. This systematic review and meta-analysis aimed to evaluate the effectiveness of electroencephalogram-guided anesthesia in preventing postoperative delirium among elderly surgical patients. Pooled effect estimates for all outcomes were calculated using a random-effects model. The quality and certainty of the evidence were assessed using the GRADE methodology. The primary outcome was the occurrence of postoperative delirium. Results: Of the 3,151 studies screened, 12 were deemed eligible for inclusion, encompassing a total of 7,441 patients, of whom 3,707 received EEG-guided anesthesia. Compared with standard care, EEG-guided anesthesia demonstrated a beneficial effect in reducing postoperative delirium among elderly patients (RR = 0.76, 95% CI: 0.61–0.96), as well as the incidence of postoperative infections (RR = 0.74, 95% CI: 0.58–0.95). Subgroup analyses revealed no significant interaction based on type of surgery (p = 0.18). Conclusion: EEG-guided anesthesia is associated with a reduced incidence of postoperative delirium in elderly surgical patients.