Association between ankle brachial index and development of postoperative intensive care unit delirium in patients with peripheral arterial disease

Abstract

Patients with vascular diseases are prone to developing postoperative delirium (POD). Ankle brachial index (ABI) is a non-invasive clinical indicator of lower-extremities peripheral arterial disease (PAD) and has been identified as an indicator of cognitive impairment. We investigated the association between ABI and POD. 683 PAD patients who underwent elective leg arterial bypass surgery between October 1998 and August 2019 were collected for retrospective analysis. Demographic information, comorbidities, preoperative ABI and the Rutherford classification within one month prior to surgery were obtained. POD was assessed using the Confusion assessment method -intensive care unit. Logistic regression and receiver operating characteristics (ROC) curve analysis were used to assess the association between ABI and POD. The mean value of ABI was significantly lower in patients with POD than it was those without POD. Older age, more medical comorbidities, longer length of surgery, decreased ABI, and higher Rutherford class were all significantly associated with POD. The area under ROC (0.74) revealed that ABI below 0.35 was associated with development of POD. Lower preoperative ABI was associated with POD in PAD patients who underwent arterial bypass surgery.

The Role of Vascular Risk Factors in Post-Stroke Delirium: A Systematic Review and Meta-Analysis

“…Moreover, the ORs follow that of the most-weighted study (Kotfis et al 2019 for the HF and Kotfis et al 2018 for the PVD), the exclusion of which in the sensitivity analysis led to no-longer statistically significant results. Finally, as HF and PVD have also been reported as risk factors for delirium in non-stroke patients [ 83 , 84 ], further studies are needed for a robust generalizability of the role of these two factors in PSD.…”

Taming Postoperative Delirium with Dexmedetomidine: A Review of the Therapeutic Agent’s Neuroprotective Effects following Surgery

“…Peripheral arterial disease (PAD) has been associated with underlying cerebrovascular disease [43]. Patients with PAD undergoing elective lower extremity bypass surgery were found to have a greater incidence of POD with more advanced PAD, measured by both lower ankle-brachial index values and higher Rutherford class [44]. The above vascular and cardiothoracic surgery investigations have both demonstrated that a disturbance in cerebrovascular perfusion has been associated with POD and lend credence to a microemboli or watershed stroke theory being involved with the etiology of POD (Figure 1).…”