• Muhan Li, Tingting Ma, Xueke Yin, Xin Zhang, Tenghai Long, Min Zeng, Juan Wang, Qianyu Cui, Shu Li, Daniel I Sessler, Rong Wang, and Yuming Peng.
• Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China. Electronic address: limuhan8816@163.com.
• J Clin Anesth. 2025 Feb 1; 101: 111733111733.

BackgroundsThe cerebral oximetry index (COx) uses near-infrared spectroscopy to estimate cerebral autoregulation during cardiac surgery. However, the relationship between intraoperative loss of cerebral autoregulation and postoperative delirium or stroke remains unclear in patients recovering from carotid endarterectomy (CEA).MethodsOur prospective observational cohort study enrolled patients scheduled for CEA. COx was estimated as the coefficient of a continuous, moving Spearman correlation between mean arterial pressure and cerebral oxygen saturation. A receiver operating characteristics curve with Youden's index identified the optimal COx threshold for predicting a composite of postoperative delirium or new-onset overt stroke.ResultsOne hundred and forty patients scheduled for CEA were enrolled. The incidence of delirium was 10.7 % (15/140) and the incidence of stroke was 3.6 % (5/140), including 1 patient who had both. The cumulative anesthesia time when COx exceeded 0.3 was longer in patients with complications than those without. When COx > 0.6, the corresponding predictive ability was AUC = 0.69, Youden index = 0.61, P = 0.0003, with a positive predictive value of 100 %. In the post hoc subgroup analyses, before clamping, the greatest increase in the risk was observed when COx > 0.7 for 20 min (Odds ratio = 3.10, 95 % CI 2.20, 3.78). In contrast, COx was not predictive during clamping. After clamping, the optimal COx threshold was 0.4 (AUC = 0.85, Youden index = 0.82, P < 0.0001), with the positive predictive value being 100 %.ConclusionsCOx is a promising metric for predicting postoperative delirium or new-onset overt stroke in patients having CEA. The optimal COx threshold was 0.7 in the pre-clamping phase and 0.4 in the post-clamping phase.Copyright © 2024 Elsevier Inc. All rights reserved.

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