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The Value of the Aperiodic Exponent of the Intraoperative Electroencephalogram for Predicting Postoperative Delirium in Elderly Patients.

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Τίτλος: The Value of the Aperiodic Exponent of the Intraoperative Electroencephalogram for Predicting Postoperative Delirium in Elderly Patients.
Συγγραφείς: Soehle M; From the Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany., Menzenbach J, Riedel K, Coburn M, Thudium M
Πηγή: Anesthesia and analgesia [Anesth Analg] 2026 Oct 01; Vol. 143 (4), pp. 849-857. Date of Electronic Publication: 2026 Mar 17.
Τύπος έκδοσης: Journal Article; Observational Study
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 1310650 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1526-7598 (Electronic) Linking ISSN: 00032999 NLM ISO Abbreviation: Anesth Analg Subsets: MEDLINE
Imprint Name(s): Publication: 1998- : Baltimore, Md. : Lippincott Williams & Wilkins
Original Publication: Cleveland, International Anesthesia Research Society.
Ιατρικοί όροι (MeSH): Electroencephalography*/methods , Emergence Delirium*/diagnosis , Emergence Delirium*/physiopathology , Emergence Delirium*/psychology , Emergence Delirium*/etiology , Intraoperative Neurophysiological Monitoring*/methods , Delirium*/diagnosis , Delirium*/psychology , Monitoring, Intraoperative*/methods, Humans ; Female ; Prospective Studies ; Predictive Value of Tests ; Male ; Aged ; Risk Factors ; Middle Aged ; Age Factors ; Risk Assessment ; Consciousness Monitors ; Aged, 80 and over
Περίληψη: Background: Postoperative delirium (POD) is a frequent and serious complication after surgery. Parameters of the electroencephalogram (EEG), such as the Bispectral Index and the occurrence of burst suppression, have been associated with POD. We analyzed the predictive properties of periodic and aperiodic parameters of the EEG power spectrum.
Methods: In a secondary post-hoc analysis of a prospective observational study, patients with an age of at least 60 years undergoing major cardiac or non-cardiac surgery were analyzed. The frontal intraoperative raw EEG was recorded by a BIS monitor and offline analyzed with the FOOOF toolbox, revealing the periodic and aperiodic parameters of the power spectrum. Patients were screened for POD and divided in a 2:1 ratio into a training and a validation cohort. Predictors of POD were identified by uni- and multivariable logistic regression.
Results: Thirty-two out of the 120 training group patients developed POD. These showed a significantly longer median duration of surgery (286 [interquartile range {IQR} 236-391] vs 223 [127-331] min, P = .005), lower median BIS (40.4 [IQR 38.1-43.4] vs 42.7 [39.5-46.0], P = .038), and a higher mean aperiodic exponent (2.09 ± 0.19 vs 1.99 ± 0.17, P = .017). Duration of surgery (odds ratio [OR] = 1.01; 95% confidence interval [CI], 1.00-1.01, P = .005), peak center frequency (OR = 0.79; CI, 0.62-0.97, P = .039) and aperiodic exponent (OR = 23.2; CI, 2.1-318.2, P = .013) were predictors of POD according to univariable logistic regression. At a cutoff of 1.967, the aperiodic exponent had a sensitivity of 0.813 and a specificity of 0.478 for the prediction of POD. A low duration of time spent in burst suppression was observed in both patients with POD (67 [6-363] s) and without POD (173 [4-641] s, P = .30), and cumulative burst suppression time was not a predictor of POD. In a stepwise regression model, age, duration of surgery, peak power, and the aperiodic exponent were associated with POD (AUROC = 0.80 (CI, 0.71-0.89, P < .001). The predictive model was confirmed in the validation group (n = 60) with an AUROC = 0.77 (CI, 0.65-0.90, P = .001).
Conclusions: A higher aperiodic exponent, for example, a less complex EEG signal, is associated with a greater POD risk, especially in combination with known POD predictors such as age and duration of surgery.
(Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, LLC. on behalf of the International Anesthesia Research Society.)
Competing Interests: Conflicts of Interest, Funding: Please see DISCLOSURES at the end of this article.
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Entry Date(s): Date Created: 20260317 Date Completed: 20260915 Latest Revision: 20260922
Update Code: 20260922
PubMed Central ID: PMC13541604
DOI: 10.1213/ANE.0000000000008013
PMID: 41841606
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1526-7598
DOI:10.1213/ANE.0000000000008013