The Impact of Electroencephalogram-Guided General Anesthesia on Postoperative Delirium and Recovery in Patients Over...

Hip fractures in the elderly often lead to high morbidity, prolonged hospitalization, and postoperative delirium-a prevalence noted to affect up to 50% of such patients. This study evaluates whether electroencephalogram (EEG)-guided general anesthesia can reduce postoperative delirium and enhance recovery in elderly hip fracture cases.

This retrospective cohort study analyzed patients aged ≥60 years who underwent hip fracture surgery under general anesthesia from November 2022 to May 2024. After propensity score matching, patients were divided into two groups: routine anesthesia (n=118) and EEG-guided anesthesia (n=105). Outcomes measured included the incidence of delirium (Confusion Assessment Method), cognitive recovery (SLUMS, Saint Louis University Mental Status Examination), hospital stay duration, post-anesthesia care unit (PACU) stay duration, and patient satisfaction.

The EEG-guided group showed significant reductions in the incidence of postoperative delirium on the first and third days (8.57% vs 20.34%, P=0.014, and 8.57% vs 22.88%, P=0.004, respectively). However, this difference was no longer significant on the fifth day and thereafter. The EEG-guided group also demonstrated better early cognitive recovery with higher SLUMS scores on postoperative days 1 and 3 (both P=0.008). Hospitalization outcomes favored the EEG-guided group, with shorter PACU retention and hospital stays (P < 0.001 and P=0.008, respectively). Patient satisfaction was significantly higher in the EEG-guided group (P=0.007). Logistic regression identified EEG-guided anesthesia as a protective factor against delirium (OR 0.316; 95% CI, 0.134-0.685; P=0.005), reduced burst suppression duration, and reduced propofol dosage.

EEG-guided general anesthesia seems to be associated with lower rates of early postoperative delirium and improved cognitive recovery in elderly patients with hip fractures.