Effect of electroencephalogram-guided anaesthesia administration on 1-yr mortality: follow-up of a randomised clinical trial

• DOI: 10.1016/j.bja.2021.04.036
• Publication Date: 2021-07-07T10:12:01Z
• Authors: Bradley A. Fritz; Christopher R. King; Angela M. Mickle; Troy S. Wildes; Thaddeus P. Budelier; Jordan Oberhaus; Daniel Park; Hannah R. Maybrier; Arbi Ben Abdallah; Alex Kronzer; Sherry L. McKinnon; Brian A. Torres; Thomas J. Graetz; Daniel A. Emmert; Ben J. Palanca; Tracey W. Stevens; Susan L. Stark; Eric J. Lenze; Michael S. Avidan; Arbi B. Abdallah; Ginika Apakama; Amrita Aranake-Ch...; Michael S. Avidan; Jacob Bolzenius; Thaddeus P. Budelier; Jamila Burton; Victoria Cui; Daniel A. Emmert; Bradley A. Fritz; Shreya Goswami; Thomas J. Graetz; Shelly Gupta; Katherine Jordan; Alex Kronzer; Hannah R. Maybrier; Sherry L. McKinnon; Angela M. Mickle; Maxwell R. Muench; Matthew R. Murphy; Jordan Oberhaus; Ben J. Palanca; Daniel Park; Aamil Patel; James W. Spencer; Tracey W. Stevens; Patricia Strutz; Catherine M. Tede...; Brian A. Torres; Emma R. Trammel; Ravi T. Upadhyayula; Troy S. Wildes; Anke C. Winter; Nan Lin; Eric Jacobsohn; Tamara Fong; Jackie Gallagher; Sharon K. Inouye; Eva M. Schmitt; Emily Somerville; Susan Stark; Eric J. Lenze; Spencer J. Melby; Jennifer Tappenden
• Keywords: Male; Missouri; Time Factors; Intraoperative Neurophysiological Monitoring; Delirium; Electroencephalography; Middle Aged; Risk Assessment; 3. Good health; 03 medical and health sciences; Consciousness Monitors; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Postoperative Cognitive Complications; Predictive Value of Tests; Risk Factors; Quality of Life; Humans; Accidental Falls; Anesthesia; Female; Aged

Intraoperative EEG suppression duration has been associated with postoperative delirium and mortality. In a clinical trial testing anaesthesia titration to avoid EEG suppression, the intervention did not decrease the incidence of postoperative delirium, but was associated with reduced 30-day mortality. The present study evaluated whether the EEG-guided anaesthesia intervention was also associated with reduced 1-yr mortality.This manuscript reports 1 yr follow-up of subjects from a single-centre RCT, including a post hoc secondary outcome (1-yr mortality) in addition to pre-specified secondary outcomes. The trial included subjects aged 60 yr or older undergoing surgery with general anaesthesia between January 2015 and May 2018. Patients were randomised to receive EEG-guided anaesthesia or usual care. The previously reported primary outcome was postoperative delirium. The outcome of the current study was all-cause 1-yr mortality.Of the 1232 subjects enrolled, 614 subjects were randomised to EEG-guided anaesthesia and 618 subjects to usual care. One-year mortality was 57/591 (9.6%) in the guided group and 62/601 (10.3%) in the usual-care group. No significant difference in mortality was observed (adjusted absolute risk difference, -0.7%; 99.5% confidence interval, -5.8% to 4.3%; P=0.68).An EEG-guided anaesthesia intervention aiming to decrease duration of EEG suppression during surgery did not significantly decrease 1-yr mortality. These findings, in the context of other studies, do not provide supportive evidence for EEG-guided anaesthesia to prevent intermediate term postoperative death.NCT02241655.