Effect of a Tailored Educational Programme on Adequacy of Anaesthesia and Major Postoperative Complications: A Before–After Quality-Improvement Study in Intermediate- and High-Risk Surgery

State Entropy (SE) and Surgical Pleth Index (SPI) parameters aim to optimise anaesthetic depth and intraoperative opioid administration, but their impact on postoperative complications remains unclear. Insufficient training and limited decision support may contribute to inconsistent findings. Thus, we evaluated whether tailored training to improve SE and SPI compliance reduced major postoperative complications. Adult inpatients undergoing intermediate- to high-risk noncardiac surgery were included in this prospective single-centre before-after study in France. The educational intervention and outcomes were based on the Kirkpatrick framework. All anaesthesia providers were invited to participate voluntarily in lectures and bedside training on SE and SPI monitoring. Training impact was assessed using a composite of major postoperative complications within 28 days as the primary outcome. Secondary outcomes included changes in monitoring practices. Among 1,623 eligible patients, 1,025 were included over a 13-month period (517 before and 508 after training). Of 202 eligible providers, 91 participated in the one-month training programme (45%). After training, simultaneous SE and SPI sensor use increased from 26% to 42% (P < 0.001), and combined SE-SPI compliance increased from 23% to 39% (P < 0.001). Major postoperative complications occurred in 66/517 patients (13%) before and 71/508 patients (14%) after training (P = 0.6). Multivariable and propensity score analyses showed no significant association between the intervention and the primary outcome. This training did not reduce the incidence of major postoperative complications, despite improvements in intraoperative monitoring practices. Future educational strategies should strengthen provider engagement and reinforcement to translate improved monitoring practices into clinical benefit. ClinicalTrials.gov: NCT06111248.