Intra-operative electroencephalogram frontal alpha-band spectral analysis and postoperative delirium in cardiac surgery

BACKGROUND Postoperative delirium (POD) remains a frequent complication after cardiac surgery, with pre-operative cognitive status being one of the main predisposing factors. However, performing complete pre-operative neuropsychological testing is challenging. The magnitude of frontal electroencephalographic (EEG) α oscillations during general anaesthesia has been related to pre-operative cognition and could constitute a functional marker for brain vulnerability. OBJECTIVE We hypothesised that features of intra-operative α-band activity could predict the occurrence of POD. DESIGN Single-centre prospective observational study. SETTING University hospital, from 15 May 2019 to 15 December 2021. PATIENTS Adult patients undergoing elective cardiac surgery. MAIN OUTCOME MEASURES Pre-operative cognitive status was assessed by neuropsychological tests and scored as a global z score. A 5-min EEG recording was obtained 30 min after induction of anaesthesia. Anaesthesia was maintained with sevoflurane. Power and peak frequency in the α-band were extracted from the frequency spectra. POD was assessed using the Confusion Assessment Method for Intensive Care Unit, the Confusion Assessment Method and a chart review. RESULTS Sixty-five (29.5%) of 220 patients developed POD. Delirious patients were significantly older with median [IQR] ages of 74 [64 to 79] years vs. 67 [59 to 74] years; P < 0.001) and had lower pre-operative cognitive z scores (−0.52 ± 1.14 vs. 0.21 ± 0.84; P < 0.001). Mean α power (−14.03 ± 4.61 dB vs. −11.59 ± 3.37 dB; P < 0.001) and maximum α power (−11.36 ± 5.28 dB vs. −8.85 ± 3.90 dB; P < 0.001) were significantly lower in delirious patients. Intra-operative mean α power was significantly associated with the probability of developing POD (adjusted odds ratio, 0.88; 95% confidence interval (CI), 0.81 to 0.96; P = 0.007), independently of age and only whenever cognitive status was not considered. CONCLUSION A lower intra-operative frontal α-band power is associated with a higher incidence of POD after cardiac surgery. Intra-operative measures of α power could constitute a means of identifying patients at risk of this complication. TRIAL REGISTRATION NCT03706989.