Perioperative Neuroprotection

Surviving surgery
is not enough.

The Safe Brain Initiative translates validated science into bedside practice — protecting patients from postoperative delirium, cognitive dysfunction, and avoidable neurological harm.

$44,291
Annual cost of a single delirium case per patient
Gou et al., 2021 · $32.9B annual US Medicare burden
18,697 patients
Multicentre dataset validating the 18-point care bundle
SBI Core Bundle · 18 participating centres
OR 0.96/month
Odds ratio reduction in delirium risk per month of implementation
Progressive improvement · Learning Healthcare System model
Live EEG Trace Simulation
SCROLL
Hub & Spoke Architecture

Where do you fit in?

SBI addresses three distinct stakeholders. Choose your role to access content calibrated for your specific clinical, economic, or personal context.

Impact Dashboard

A growing global standard

13
Active countries in the SBI network
EUROPE · ASIA · MIDDLE EAST · AMERICAS
500+
Trained SBI Champions by Year 1 target
BASIC · ADVANCED · ULTIMATE
18
Evidence-based care bundle components validated
MULTICENTRE COHORT · N=18,697
5
Core publications forming the Tetralogy
BJA · eLife · PAIN · ANESTHESIOLOGY
The Science

The Tetralogy framework

Four interconnected pillars from foundational physiology to real-world implementation, each supported by peer-reviewed evidence.

01 / PRINCIPLES

Why the brain is vulnerable

Physiological rationale for why surgical anaesthesia creates a window of neurological risk — independent of pre-existing pathology.

→ Read foundational paper
02 / FRAMEWORK

The PC² Model

Patient-Centred Precision Care: a structured methodology linking intraoperative monitoring with postoperative functional outcomes.

→ BJA Editorial
03 / EVIDENCE

18,697 patients

Multicentre real-world data validating the 18-point bundle across surgical specialties, geographies, and patient risk profiles.

→ See dataset
04 / IMPLEMENTATION

From ward to bedside

Practical protocols, SOPs, and learning system architecture ensuring the 0.96 OR/month improvement compounds over time.

→ Download bundle checklist
Spoke 01 — Clinician Journey

Evidence does not implement itself.

The SBI Clinician Spoke provides the competency pathway, tools, and peer network to move from published data to clinical habit — one operating room at a time.

The Pulse Oximetry Precedent

Pulse oximetry became a universal standard based on physiological rationale, not mortality trials. The 1993 Møller study of 20,802 patients showed a 19-fold increase in hypoxemia detection without a mortality benefit — and yet no one questions its use today. Brain monitoring meets the same threshold.

📋
Clinical Assessment Forms
Nu-DESC · QoR-15 · WHODAS 2.0 · Mini-Cog
🔬
18-Point SBI Care Bundle
Fluid fasting · EEG monitoring · Pain · Sleep · Delirium prevention

EEG Bootcamp: three paths to competency

BASIC
EEG Signatures & Burst Suppression
Recognition, interpretation, and clinical response
1 day
ADVANCED
Spectral Analysis & Department Implementation
Departmental bundle rollout and monitoring integration
2 days
ULTIMATE
SBI Champion Certification
Mentorship, implementation lead status, global network access
3 days + mentorship
Conversion Pathway
Awareness
Journal publication, social media, conference presentation
Interest
Evidence Library → Tetralogy navigator
Competency
BASIC or ADVANCED Bootcamp registration
Leadership
SBI Champion → ULTIMATE + Fellowship network
Implementation effect
-4% / month

Compound delirium risk reduction with sustained bundle use

Spoke 02 — Executive Journey

Inaction is not neutral. It is expensive.

Every month without a neuroprotection programme is a month of preventable delirium cases, extended ICU stays, and unnecessary readmissions billed to your institution.

The SBI framework reframes anaesthesia from an event to a service — where outcomes, not processes, determine value. Under the Value-Based Healthcare Equation (Value = Outcomes / Cost), perioperative brain health is a financial instrument, not merely a clinical preference.

Annual US Medicare burden
$32.9B

Attributed to postoperative delirium complications

Cost of a single delirium case
$44k

Per patient per year (Gou et al., 2021)

SBI Muda — Lean waste categories
7

Identifiable waste streams eliminated by bundle implementation

ESG / Green Plan alignment
↓ICU

Reduced ICU days and medication waste improve sustainability scoring

ROI Calculator

Estimate your institution's annual cost of inaction.

5,000 procedures/year
15% incidence
30% reduction
Current delirium cases / year750
Cases preventable with SBI bundle225
Estimated annual savings$9,965,475

Based on $44,291/case (Gou et al., 2021). Model for estimation purposes only.

Spoke 03 — Patient Journey

You have the right to return whole.

Surviving surgery is the baseline, not the goal. The goal is returning to the life you had — with your memory, your personality, and your independence intact.

Postoperative delirium and cognitive dysfunction are not inevitable. They are largely preventable, and you can advocate for the monitoring and care bundle that reduces your risk. Ask your anaesthetist a direct question before you go to theatre.

The checklist on the right is yours to print and bring to your pre-operative assessment. You are entitled to shared decision-making. This is what it looks like in practice.

Questions to ask your anaesthetist

  • Will brain monitoring (processed EEG) be used during my anaesthesia?
  • Has your department implemented a neuroprotection care bundle?
  • How will my cognitive function be assessed before I am discharged?
  • What is your protocol if I develop postoperative confusion or delirium?
  • Will I receive a follow-up assessment at 30 days after surgery?
  • Is this hospital affiliated with the Safe Brain Initiative?
Find an SBI-affiliated hospital

Search by country or region

13
COUNTRIES
Data Integration Gateway

Closing the loop

Neuroprotection requires both a process measure and an outcome measure. One without the other is incomplete science.

📡
Process Measure

Intraoperative EEG

Real-time guidance. Burst suppression detection. Titration of anaesthetic depth. The GPS of neuroprotection.

Dual
Loop
📋
Outcome Measure

PROMs at 30 days

QoR-15 and WHODAS 2.0 verify cognitive and functional return to baseline — closing the evidence loop.

Risk Stratification Tool

Mini-Cog + ASA status calculator to determine bundle intensity for each patient.

Institutional Dashboard

Real-time benchmarking against global SBI network averages. GDPR-compliant, EU-hosted.

Global Community

SBI is present in 13 countries

A growing network of clinicians, institutions, and champions committed to making neuroprotective care the perioperative default.

🇧🇪 Belgium
🇩🇰 Denmark
🇩🇪 Germany
🇳🇴 Norway
🇵🇹 Portugal
🇸🇦 Saudi Arabia
🏴󠁧󠁢󠁳󠁣󠁴󠁿 Scotland
🇸🇬 Singapore
🇪🇸 Spain
🇨🇭 Switzerland
🇹🇷 Turkey
🇺🇸 USA
+ Asia-Pacific / Middle East expanding 2025
12-Month Implementation Roadmap

From platform to practice

MONTHS 1–3

Foundation

Narrative infrastructure and digital architecture.

  • Messaging Guide V.2
  • LinkedIn activation
  • BJA Launch Kit
MONTHS 4–6

Acceleration

Content scaling and first training pilots.

  • Clinician Spoke MVP live
  • "Event vs Service" campaign
  • Online BASIC Bootcamp pilot
MONTHS 7–9

Scale

Institutional partnerships and journal submissions.

  • Executive Spoke + ROI Calculator
  • JAMA/NEJM submission
  • First industry MOU
MONTHS 10–12

Sustainability

Global data integration and Year 1 reporting.

  • Data Gateway launch
  • Year 1 Impact Report
  • Asia-Pacific / Middle East expansion
MetricMonth 3Month 6Month 12
Web visitors / month2,0005,00015,000
LinkedIn followers1,5005,00010,000
Trained Champions60200500
End the Lost Decade

Every month of delay is a month of preventable harm.

Just as H. pylori's discovery took a decade to change gastric ulcer practice at the cost of 500,000 unnecessary surgeries, perioperative medicine faces the same choice today: inertia or implementation.