Postoperative delirium and the limits of EEG monitoring without goal-directed anesthetic management

BACKGROUND: Postoperative delirium (POD) remains a major cause of morbidity after surgery. Understanding its relationship with anesthetic depth and EEG monitoring could optimize perioperative management and improve patient recovery. This study aimed to determine whether intraoperative monitoring of anesthetic depth using integrated EEG is associated with a reduced incidence of POD. METHODS: Observational multicentre study conducted across 43 hospitals. 1,690 adults (≥18 years) undergoing surgery under general anesthesia were included. The primary outcome was the incidence of POD at 48 hours post-surgery, comparing patients who received intraoperative EEG-based anesthetic depth monitoring with those who did not. POD diagnosis was based on established clinical criteria. In addition, a cross-sectional survey was administered to participating anesthesiologists to assess patterns of EEG monitor use, target ranges, training, and perceptions regarding its role in delirium prevention. RESULTS: POD occurred in 4.25% (61/1434) of patients who received EEG monitoring and in 1.56% (4/256) of those without (P=0.833). Logistic regression identified age as significantly associated with POD (OR 1.06, 95% CI: 1.04-1.09, P<0.001), while neither EEG monitoring (OR 2.66, 95% CI: 0.95-7.45, P=0.063) nor sex (OR 1.15, 95% CI: 0.69-1.91, P=0.586) were independent predictors. In a survey involving 493 anesthesiologists, a widespread use of EEG monitoring was observed in clinical practice (61% use it consistently, and 35% frequently), with the most common target range being 40-60 (82.6%). The vast majority of respondents (96.7%) perceived a potential benefit in delirium prevention. However, only 35.2% had received formal training, and the application of goal-directed, protocolized EEG monitoring remained heterogeneous. CONCLUSIONS: In real-world clinical practice, intraoperative anesthetic depth monitoring was not associated with a lower incidence of POD at 48 hours. Heterogeneous, non-protocolized use and lack of structured training may limit its effectiveness. These findings should be considered hypothesis-generating and highlight the need for implementation strategies and goal-directed use.

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Journal
Minerva Anestesiologica
Published
2026-05-01
DOI
https://doi.org/10.23736/s0375-9393.26.19737-5
Primary Topic
Intensive Care Unit Cognitive Disorders
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article
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article

Postoperative delirium and the limits of EEG monitoring without goal-directed anesthetic management

C. Ferrer Gómez, Jorge Fernández Rodríguez, Rosalía Navarro Pérez, Beneharo Dárias-Delbey et al.
Minerva Anestesiologica
Intensive Care Unit Cognitive Disorders
article

Postoperative delirium and the limits of EEG monitoring without goal-directed anesthetic management

C. Ferrer Gómez, Jorge Fernández Rodríguez, Rosalía Navarro Pérez, Beneharo Dárias-Delbey, Almudena Gonzalez Pereira, J Letéllez Fernández, Lorena Varela Rodríguez, Pablo González Montes, Marta de la Rosa-Estadella, Gustavo Illodo Miramontes, María Heredia Rodríguez, Antonio Rodriguez Calvo, Rodrigo Poves‐Álvarez, Eduardo Tamayo, Beatriz Martínez‐Rafael, Nekane Romero-García, Laura Pariente Juste, Laura Contreras-Lopez, Ricardo Fernández Fernández, Raquel Fernández-García, Estefanía Gómez Pesquera, Ane Guereca Gala, Rocío López-Herrero, Olga de la Varga-Martínez, Marta Giné Servén, Marta Alonso Fernández, Ainhoa Renedo Fernández, Cristina González, Rita Veloso de Sousa, Marina Varela Durán, Natalia Bugueño, Elena del Val Peciña, Laura Edo Cebollada, Patricia Cid Boo, María Artiaga-Candia, Ángel Becerra‐Bolaños, Maria E. INFANTES MORALES, Carla DELGADO MARTÍ, Felipe ROCHA GARCÍA, Ángel A. RODRÍGUEZ ÁLVAREZ, Alberto MARTÍNEZ RUIZ, Guadalupe POBLACIÓN GARCÍA, José M. MARCOS-VIDAL, María A. RODRÍGUEZ CONESA, José RAMÍREZ-ESTEBAN, Gabriel ESCUDERO GÓMEZ, Leticia NARVÁEZ RODRÍGUEZ, Cristina TOBAR GONZALO, Diana M. NARVÁEZ CUBILLOS, Luis Á. GÓMEZ ARREDONDO, Aurora HERRERA SOTO, Adrián MATUTE GONZÁLEZ, Rafael BADENES, Iria DE LA TORRE RIVEIRO, Alma M. ESPINOSA MORENO, José I. GARCÍA SÁNCHEZ, María F. MUÑOZ-MORENO, Amparo CASASEMPERE SANUS, Adrián MARTÍNEZ LÓPEZ
article en

Abstract

BACKGROUND: Postoperative delirium (POD) remains a major cause of morbidity after surgery. Understanding its relationship with anesthetic depth and EEG monitoring could optimize perioperative management and improve patient recovery. This study aimed to determine whether intraoperative monitoring of anesthetic depth using integrated EEG is associated with a reduced incidence of POD. METHODS: Observational multicentre study conducted across 43 hospitals. 1,690 adults (≥18 years) undergoing surgery under general anesthesia were included. The primary outcome was the incidence of POD at 48 hours post-surgery, comparing patients who received intraoperative EEG-based anesthetic depth monitoring with those who did not. POD diagnosis was based on established clinical criteria. In addition, a cross-sectional survey was administered to participating anesthesiologists to assess patterns of EEG monitor use, target ranges, training, and perceptions regarding its role in delirium prevention. RESULTS: POD occurred in 4.25% (61/1434) of patients who received EEG monitoring and in 1.56% (4/256) of those without (P=0.833). Logistic regression identified age as significantly associated with POD (OR 1.06, 95% CI: 1.04-1.09, P<0.001), while neither EEG monitoring (OR 2.66, 95% CI: 0.95-7.45, P=0.063) nor sex (OR 1.15, 95% CI: 0.69-1.91, P=0.586) were independent predictors. In a survey involving 493 anesthesiologists, a widespread use of EEG monitoring was observed in clinical practice (61% use it consistently, and 35% frequently), with the most common target range being 40-60 (82.6%). The vast majority of respondents (96.7%) perceived a potential benefit in delirium prevention. However, only 35.2% had received formal training, and the application of goal-directed, protocolized EEG monitoring remained heterogeneous. CONCLUSIONS: In real-world clinical practice, intraoperative anesthetic depth monitoring was not associated with a lower incidence of POD at 48 hours. Heterogeneous, non-protocolized use and lack of structured training may limit its effectiveness. These findings should be considered hypothesis-generating and highlight the need for implementation strategies and goal-directed use.

Minerva Anestesiologica
Universidad de Valladolid (ES), Universidade da Coruña (ES), Universitat de València (ES), Universidad de Salamanca (ES), Universidade de Santiago de Compostela (ES), Universidad Nacional Experimental Simón Rodríguez (VE), Hospital Universitario Insular de Gran Canaria (ES), Instituto de Salud Carlos III (ES), Hospital de Sant Pau (ES), Bellvitge University Hospital (ES), University Hospital Complex Of Vigo (ES), Hospital Clínico San Carlos (ES), Research Institute Hospital 12 de Octubre (ES), Institut d'Investigació Biomédica de Bellvitge (ES), Hospital Universitari Sant Joan D'Alacant (ES), Hospital de Basurto (ES), Hospital Clínico Universitario de Valencia (ES), Complejo Hospitalario Universitario de Santiago (ES), Hospital Universitario de Gran Canaria Doctor Negrín (ES), Hospital Leforte (BR), Marqués de Valdecilla University Hospital (ES), Biogipuzkoa Health Research Institute (ES), Hospital Universitario del Tajo (ES), Hospital Universitario Fundación Alcorcón (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Centre for Biomedical Network Research on Rare Diseases (ES), CIC bioGUNE (ES), Instituto de Investigación Biosanitaria de Granada (ES), Hospital Universitario Miguel Servet (ES), Corporació Sanitària Parc Taulí (ES), Hospital Universitario de Burgos (ES), Hospital de Manises (ES), Hospital General Universitari de Castelló (ES), Hospital Universitario Doctor Peset (ES), Hospital General Universitario De Valencia (ES), Hospital Universitario de La Princesa (ES), Hospital Universitario Central de Asturias (ES), Hospital de Cruces (ES), Povisa Hospital (ES), Hospital Universitario Lucus Augusti (ES), Hospital Universitario de Fuenlabrada (ES), Hospital Universitario De Cabueñes (ES), Hospital Universitario del Henares (ES), Hospital Universitario de Móstoles (ES), Hospital Clínico Universitario de Valladolid (ES), INCLIVA Health Research Institute (ES), Complejo Hospitalario de Pontevedra (ES), Hospital Universitario de León (ES), Hospital Central de la Defensa Gómez Ulla (ES), Complejo Hospitalario de Ourense (ES), Hospital Universitario Infanta Leonor (ES), Complejo Hospitalario Universitario de Ferrol (ES), Universidad de Burgos (ES), Universitat de Barcelona (ES)
Good health and well-being
Openalex Percentile: Top 7%
Intensive Care Unit Cognitive Disorders
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