Our primary analysis demonstrated a highly sensitive result with a pooled analysis of trials in which the intervention group adhered to manufacturer’s recommended guidelines showing reduced incidence of postoperative delirium (POD) with processed electroencephalography (pEEG) guidance.

High clinical heterogeneity limits the inferences from this and any future meta-analyses.

Nine studies, which included 4648 eligible subjects, were identified.

The incidence of POD in the pEEG-guided general anesthesia or lighter pEEG target group was 19.0% (440/2310) compared with 23.3% (545/2338) in the usual care or deeper pEEG target group.

Significant heterogeneity was detected.

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