Role of Intraoperative Neurophysiological Monitoring in Predicting Postoperative Delirium in Patients Undergoing Carotid Endarterectomy Surgeries.

This study aims to evaluate the diagnostic utility of Electroencephalography (EEG) and Somatosensory Evoked Potentials (SSEP) as modalities of Intraoperative neurophysiological monitoring (IONM) in predicting Postoperative Delirium (POD) in patients who underwent Carotid Endarterectomy (CEA) surgery. A total cohort of 425 patients were included in this study. Medical record data was reviewed retrospectively and their documented significant IONM data were analyzed and integrated into the study for each patient. The study cohort was assessed for POD with Intensive Care Delirium Screening Checklist (ICDSC) and a score of >4 was positive for delirium. Of the 425 patients that underwent CEA for carotid stenosis, 65/425 (15.29%) had documented significant IONM changes. Of those 65 patients with significant changes, 16 (24.61%) had POD. On the other hand, of the 360 patients without changes, 31 (8.61%) had POD. On performing multivariable analysis and adjusting for possible confounders, IONM changes were still significantly associated with POD (p value: <0.001; 95% C.I. 1.91-7.98; OR: 3.94). Specifically, SSEP changes alone were significantly associated with POD (p value: <0.001; 95% C.I. 2.36-11.08; OR: 5.15). Significant IONM changes increase the risk of developing POD in patients undergoing CEA. Despite the low overall risk of POD after CEA in our study, it is imperative to conclude that patients with POD are twice likely to exhibit changes.

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S. Karger AG, Basel.