Effect of electroencephalogram-guided anaesthesia administration on 1-yr mortality: follow-up of a randomised clinical trial. (September 2021)

• Record Type: Journal Article
• Authors: Fritz, Bradley A.; King, Christopher R.; Mickle, Angela M.; Wildes, Troy S.; Budelier, Thaddeus P.; Oberhaus, Jordan; Park, Daniel; Maybrier, Hannah R.; Ben Abdallah, Arbi; Kronzer, Alex; McKinnon, Sherry L.; Torres, Brian A.; Graetz, Thomas J.; Emmert, Daniel A.; Palanca, Ben J.; Stevens, Tracey W.; Stark, Susan L.; Lenze, Eric J.; Avidan, Michael S.; Abdallah, Arbi B.; Apakama, Ginika; Aranake-Chrisinger, Amrita; Avidan, Michael S.; Bolzenius, Jacob; Budelier, Thaddeus P.; Burton, Jamila; Cui, Victoria; Emmert, Daniel A.; Fritz, Bradley A.; Goswami, Shreya; Graetz, Thomas J.; Gupta, Shelly; Jordan, Katherine; Kronzer, Alex; Maybrier, Hannah R.; McKinnon, Sherry L.; Mickle, Angela M.; Muench, Maxwell R.; Murphy, Matthew R.; Oberhaus, Jordan; Palanca, Ben J.; Park, Daniel; Patel, Aamil; Spencer, James W.; Stevens, Tracey W.; Strutz, Patricia; Tedeschi, Catherine M.; Torres, Brian A.; Trammel, Emma R.; Upadhyayula, Ravi T.; Wildes, Troy S.; Winter, Anke C.; Lin, Nan; Jacobsohn, Eric; Fong, Tamara; Gallagher, Jackie; Inouye, Sharon K.; Schmitt, Eva M.; Somerville, Emily; Stark, Susan; Lenze, Eric J.; Melby, Spencer J.; Tappenden, Jennifer;
• Is Part Of: British journal of anaesthesia. Volume 127:Number 3(2021)
• Page Start: 386
• Page End: 395
• Publication Date: 2021-09
• Subjects: burst suppression -- depth of anaesthesia -- electroencephalogram suppression -- postoperative death -- postoperative delirium -- postoperative falls -- postoperative mortality -- quality of life; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2021.04.036
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract: Background: 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. Methods: 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. Results: 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). Conclusions: 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. Clinical trial registration: NCT02241655.