Anesthesia-induced electroencephalogram oscillations and perioperative outcomes in older adults undergoing cardiac
Isaac G Freedman1, Gonzalo Boncompte2, Jason Z Qu1
1Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Background:
Electroencephalogram oscillations during general anesthesia may change as a function of cognitive and physical health. This study aimed to characterize associations between anesthesia-induced oscillations and postoperative outcomes in cardiac surgery patients over 60 years.
Methods:
This was a prespecified secondary data analysis from the Minimizing Intensive Care Unit Dysfunction with Dexmedetomidine-induced Sleep (MINDDS) study. Participants were admitted from home for elective cardiac surgery with cardiopulmonary bypass. The primary outcome was postoperative delirium obtained using the Confusion Assessment Method. Secondary outcomes were non-home discharge and 30-day readmission. The exposure of interest was alpha power measured during the maintenance phase of isoflurane-general anesthesia. Confounding cognitive and physical health variables were collected.
Results:
Of 394 participants in the MINDDS study, 302 had analyzable electroencephalograms. The incidence of postoperative delirium was 11.1 %. Odds of postoperative delirium decreased by 14 % for every decibel increase in alpha power (OR 0.86, 95 % CI: 0.78 to 0.95; P = 0.004). This finding was not significant in adjusted analysis (ORadj 0.92, 95 % CI: 0.81 to 1.03; P = 0.154). Non-home discharge setting findings were not associated with alpha power. The odds of 30-day readmission decreased by 20 % for every decibel increase in alpha power (ORadj 0.80, 95 % CI: 0.71 to 0.91; P < 0.001). Findings were conserved in exploratory and sensitivity analyses.
Conclusions:
In this study anesthesia-induced oscillations were associated with postoperative outcomes; however, these were not independently associated with delirium or discharge disposition after considering preoperative cognitive and physical health. These oscillations were robustly associated with 30-day readmission however, which may help anesthesiologists identify high-risk patients, offering benefits beyond the operating room.
Clinical Trial Registration:
Registration Number: NCT02856594.
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