• Bradley A Fritz, Christopher R King, Angela M Mickle, Troy S Wildes, Thaddeus P Budelier, Jordan Oberhaus, Daniel Park, Hannah R Maybrier, Ben AbdallahArbiADepartment of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA., 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, and ENGAGES Research Group.
• Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: bafritz@wustl.edu.
• Br J Anaesth. 2021 Sep 1; 127 (3): 386-395.

BackgroundIntraoperative 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.MethodsThis 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.ResultsOf 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).ConclusionsAn 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 RegistrationNCT02241655.Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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