BACKGROUND Electroencephalogram burst suppression can be associated with postoperative delirium; however, the results of relevant studies are discrepant. This systematic review and meta-analysis aimed to assess the association between intraoperative burst suppression and postoperative delirium in adult surgical patients. METHODS PubMed, MEDLINE, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials were systematically searched and updated in May 2023. We included cohort studies, case-control studies, and randomized-controlled studies reporting on postoperative delirium incidence with documented intraoperative burst suppression in adults receiving general anesthesia for any surgery. The primary outcome was the pooled odds ratio (OR) for postoperative delirium in cases with intraoperative burst suppression compared to those without burst suppression, calculated using a random-effects model. Two independent investigators extracted the data. The protocol was prospectively registered in PROSPERO (registration number: CRD42022326479); the results were reported according to PRISMA guidelines. RESULTS Fourteen studies (6435 patients) were included in the analysis. The overall incidence of postoperative delirium was 21.1% (1358/6435). Patients with intraoperative burst suppression had a higher incidence of postoperative delirium than those without burst suppression (pooled OR, 1.492; 95% confidence interval (CI) [1.022-2.178]; I2 =44%; 95% CI [0%-75%]; τ2 = 0.110). The intraoperative duration of burst suppression was significantly longer in patients who developed postoperative delirium (standardized mean difference [SMD] 0.462 [95% CI, 0.293-0.632]; I2 = 63%; 95% CI [16%-84%]; τ2 = 0.027). The burst suppression ratio was significantly higher in the delirium group (SMD 0.150; 95% CI [0.055-0.245]; I2 = 0%; 95% CI [0%-85%]; τ2 = 0.00). CONCLUSION Our meta-analysis suggests an association between intraoperative burst suppression and postoperative delirium; however, the quality of evidence was very low. The limited number of studies and substantial heterogeneity across them emphasize the need for further high-quality studies to establish a more robust conclusion.

中文翻译：

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术中脑电图爆发抑制与术后谵妄之间的关联：系统评价和荟萃分析。


背景 脑电图爆发抑制可能与术后谵妄有关;然而，相关研究的结果是不一致的。本系统评价和荟萃分析旨在评估成年手术患者术中爆发抑制与术后谵妄之间的关联。方法 2023 年 5 月系统检索和更新了 PubMed、MEDLINE、Embase、Google Scholar 和 Cochrane 对照试验中心注册库。我们纳入了队列研究、病例对照研究和随机对照研究，这些研究报告了接受全身麻醉的任何手术的成人术后谵妄发生率和术中爆发抑制的记录。主要结局是使用随机效应模型计算的术中爆发抑制病例与无爆发抑制病例相比术后谵妄的合并比值比 （OR）。两名独立研究人员提取了数据。该方案在 PROSPERO 中前瞻性注册（注册号：CRD42022326479）;根据 PRISMA 指南报告结果。结果 纳入 14 项研究 （6435 例患者） 纳入分析。术后谵妄的总发生率为 21.1% （1358/6435）。术中爆发抑制患者术后谵妄的发生率高于无爆发抑制的患者（合并OR，1.492;95%置信区间（CI）[1.022-2.178];I2 =44%;95% CI [0%-75%];τ2 = 0.110).在出现术后谵妄的患者中，爆发抑制的术中持续时间显著延长 （标准化均数差 [SMD] 0.462 [95% CI，0.293-0.632];I2 = 63%;95% CI [16%-84%];τ2 = 0.027). 谵妄组的突发抑制率显著更高（SMD 0.150;95% CI [0.055-0.245];I2 = 0%;95% CI [0%-85%];τ2 = 0.00).结论 我们的荟萃分析表明术中爆发抑制与术后谵妄之间存在关联;然而，证据质量非常低。研究数量有限且存在很大的异质性，这凸显了进一步高质量研究的必要性，以建立更可靠的结论。