Delirium following vascular surgery: increased incidence with preoperative β-blocker administration

Abstract

Purpose To determine if there is an association between perioperative administration of beta-blockers and postoperative delirium in patients undergoing vascular surgery. Methods After Institutional Review Board approval, data were retrospectively collected on patients who underwent vascular surgery in an academic hospital during the period January 2006 to January 2007. Patients with preoperative altered level of consciousness, carotid endarterectomy, or discharge within 24 h of surgery were excluded from the study. Identification of delirium was based on evaluation of the level of consciousness with the NEECHAM Confusion Scale and/or a chart-based instrument for delirium. Multivariable logistic regression analysis was used to identify independent perioperative predictors of postoperative delirium. Beta-blockers were tested for a potential effect. Conclusions Preoperative administration of beta-blockers is associated with an increased risk of postoperative delirium after vascular surgery. Conversely, preoperative statin administration is associated with a lower risk of postoperative delirium. A randomized prospective controlled trial is required to validate these findings. RésuméObjectif De´terminer s'il existe un lien entre l'administration pe´riope´ratoire de beˆta-bloquants et le delirium postope´ratoire chez les patients subissant une chirurgie vasculaire.

Hospital administrative database underestimates delirium rate after cardiac surgery

“…[6][7][8][9]13 Using an administrative database as the only source of identification of postoperative delirium could considerably underestimate the real incidence rates 14 and lead to conclusions that might conflict with the studies based on validated screening tests for postoperative delirium. 15,16 It is likely that the discrepancy in delirium rates between our two databases is based on the practice and methodology of establishing the diagnosis of delirium. It could be a reflection of inadequate data abstraction, poor communication among the care team, and/or incomplete charting by physicians.…”

Voie d’abord endovasculaire contre voie d’abord ouverte pour la chirurgie de l’anévrysme de l’aorte: incidence de delirium postopératoire

“…We used the same database for the current study as for our previous publication 4 ; however, we extended the current study to an 18-month observation period, thereby increasing the sample size of patients undergoing AAA and TAA procedures. Both elective and emergency cases were eligible for the study.…”

“…Identification of delirium was based on the assessments of the NEECHAM scores and the validated chart review instruments, as Endovascular versus open approach to aortic aneurysm repair surgery 557 described previously. 4 Patients with NEECHAM scores \ 25 and/or positive results from a validated chart review were considered to have delirium. Delirium rates were compared in all ages as well as in the subgroups of over 75 yr and under 75 yr.…”

“…[1][2][3] Recently, we reported that older age, history of cerebrovascular accident or transient ischemic attack, depression, preoperative beta-blocker administration, and open aortic reconstruction procedures were associated with a higher risk of postoperative delirium. 4 Rates of delirium after major vascular surgery vary from 30% to more than 50%. [5][6][7][8] In this study, we compared the incidence of postoperative delirium in patients undergoing OPEN aortic aneurysm repair surgery with the incidence in patients undergoing the EVAR approach.…”

The Comparison of the Effects of the Off-Pump and Cardiopulmonary By-Pass Techniques Upon Postoperative Delirium at Elective Coronary By-Pass Greft Surgery

“…'nın (27) yaptığı çalışmada, deliryum gelişen olgularda preoperatif dönemde ß-bloker kullanımının deliryum gelişmeyen olgulara göre daha yüksek olduğu bildirilmiştir. Bunu da ß-blokerlerin beta aderenerjik reseptörlerin yanı sıra deliryum patogenezinde rol alan serotonin duyarlı adenilat siklaz sistemini etkilemesine bağlamışlardır.…”