• Rory Vu Mather, Ryan Nipp, Gustavo Balanza, Tom A D Stone, Rodrigo Gutierrez, Praachi Raje, Masaya Higuchi, Ran Liu, Laura A Santa Cruz Mercado, Edward A Bittner, Hiroko Kunitake, and Patrick L Purdon.
• Harvard/MIT MD-PhD Program, Boston, Massachusetts; Harvard-MIT Program in Health Sciences and Technology, Cambridge, Massachusetts; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesia, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.
• Anesthesiology. 2025 Mar 1; 142 (3): 500510500-510.

BackgroundWith estimated global postoperative mortality rates at 1% to 4% leading to approximately 3 million to 12 million deaths per year, an urgent need exists for reliable measures of perioperative risk. Existing approaches suffer from poor performance, place a high burden on clinicians to gather data, or do not incorporate intraoperative data. Previous work demonstrated that intraoperative anesthetics induce prefrontal electroencephalogram (EEG) oscillations in the alpha band (8 to 12 Hz) that correlate with postoperative cognitive outcomes.MethodsThe authors analyzed a retrospective cohort of 1,081 patients undergoing surgery with general anesthesia at Massachusetts General Hospital (Boston, Massachusetts) with intraoperative EEG recordings. The association between EEG alpha power and adverse outcomes was characterized using statistical models that were fitted on propensity weighted data. The primary outcome was postoperative mortality, measured from date of surgery to date of death or last follow-up. Secondary outcomes included mortality within prespecified time windows (30 days, 90 days, 180 days, and 1 yr), hospital and postanesthesia care unit lengths of stay, discharge to long-term care, and 30-day hospital readmission.ResultsAlpha power was associated with mortality risk (hazard ratio, 0.92; 95% CI, 0.85 to 0.99; P = 0.039). Within specified time windows, alpha power was associated with 30-day mortality (odds ratio, 0.81; 95% CI, 0.66 to 0.95; P = 0.010), 90-day mortality (odds ratio, 0.68; 95% CI, 0.55 to 0.79; P < 0.001), 180-day mortality (odds ratio, 0.75; 95% CI, 0.66 to 0.83; P < 0.001), and 1-yr mortality (odds ratio, 0.85; 95% CI, 0.79 to 0.91; P < 0.001). Additionally, alpha power was associated with discharge to long-term care (odds ratio, 0.91; 95% CI, 0.86 to 0.96; P < 0.001). We did not find significant associations among alpha power and 30-day readmission and hospital or postanesthesia care unit lengths of stay.ConclusionsIntraoperative EEG alpha power is independently associated with postoperative mortality and adverse outcomes, suggesting it could represent a broad measure of postoperative physical resilience and provide clinicians with a low-burden, personalized measure of postoperative risk.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc., on behalf of the American Society of Anesthesiologists.

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