Preoperative electroencephalographic alpha-power changes with eyes opening are associated with postoperative attention impairment and inattention-related delirium severity

Acker, L; Wong, MK; Wright, MC; Reese, M; Giattino, CM; Roberts, KC; Au, S; Colon-Emeric, C; Lipsitz, LA; Devinney, MJ; Browndyke, J; Eleswarpu, S; Moretti, E; Whitson, HE; Berger, M; Woldorff, MG; INTUIT and PRIME study groups

doi:10.1016/j.bja.2023.10.037

Preoperative electroencephalographic alpha-power changes with eyes opening are associated with postoperative attention impairment and inattention-related delirium severity

Br J AnaesthPublished 12 Dec 2023Prospective cohort study

Main finding · Postoperative inattentionResultOdds ratio 0.73 95% CI 0.57–0.94

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Authors' conclusion

Preoperative awake, resting, EEG alpha attenuation with eyes opening might represent a neural biomarker for risk of postoperative attentional impairment.

Study context

Population: Non-neurological, noncardiac surgery patients aged ≥ 60 years with preoperative awake 32-channel EEG
Participants: 71 participants

Exposure: Magnitude of preoperative eyes-opening EEG alpha attenuation
Outcome: Postoperative inattention

Methodological detailsage- and Mini-Mental Status Examination (MMSE)-adjusted logistic and proportional-odds regression, Inattention and other delirium features assessed before surgery and twice daily after surgery until discharge

Age- and MMSE-adjusted logistic and proportional-odds regression
Inattention and other delirium features assessed before surgery and twice daily after surgery until discharge

Main finding

As reported in the abstract

Odds ratio

0.73

95% CI 0.57–0.94

P = 0.038

Alpha attenuation with eyes opening

OR 0.73 (95% CI 0.57–0.94); P = 0.038

Observational data: associations, not effects.

Further findings

Inattention chronicity (never, newly, chronically inattentive) (sensitivity analysis)

	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
Alpha-attenuation magnitudeInverse relationship	0.512	0.76 (0.62–0.93)	P = 0.019
	0.512Odds ratio (log scale)

Postoperative delirium severity

	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
Alpha-attenuation magnitude	0.512	0.79 (0.65–0.95)	P = 0.040
	0.512Odds ratio (log scale)

Postoperative delirium severity: inverse association, predominantly due to inattention feature

Original publication

Preoperative electroencephalographic alpha-power changes with eyes opening are associated with postoperative attention impairment and inattention-related delirium severity. Br J Anaesth. Published 12 December 2023. doi:10.1016/j.bja.2023.10.037

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