Incidence, prognostic factors and impact of postoperative delirium after major vascular surgery: A meta-analysis and systematic review

Abstract

Although postoperative delirium is a common complication and increases patient care needs, little is known about the predictors and outcomes of delirium in patients having vascular surgery. This review aimed to determine the incidence, prognostic factors and impact of postoperative delirium in vascular surgical patients. MEDLINE and EMBASE were systematically searched for articles published between January 2000 and January 2016 on delirium after vascular surgery. The primary outcome was the incidence of delirium. Secondary outcomes were contributing prognostic factors and impact of delirium. Study quality and risk of bias was assessed using the QUIPS tool for systematic reviews of prognostic studies, and MOOSE guidelines for reviews of observational studies. Quantitative analyses of extracted data were conducted using meta-analysis where possible to determine incidence of delirium and prognostic factors. A qualitative review of outcomes was performed. Fifteen articles were eligible for inclusion. Delirium incidence ranged between 5% and 39%. Meta-analysis found that patients with delirium were older than those without delirium (OR 3.6, p<0.001). Prognostic factors predicting delirium included increased age (OR 1.04, p<0.001), pre-existing cognitive impairment (OR 9.8, p=0.01), hypertension, pre-existing depression and open aortic surgery. Delirious patients remained in hospital 6 days longer ( p<0.001) and had more complications than patients without delirium. Data were limited on the impact of procedure complexity, endovascular compared to open surgery or type of anaesthetic. Postoperative delirium occurs frequently, resulting in major morbidity for vascular patients. Improved quality of prognostic studies may identify modifiable peri-operative factors to improve quality of care for vascular surgical patients.

Incidence and risk factors of postoperative delirium in elderly patients undergoing urological surgery: A multi‐institutional prospective study

“…In the present study, not only mental conditions, but also physical conditions were independently associated with the incidence. Many other studies have suggested preoperative cognitive impairment as a risk factor . A history of CVD is a well‐known risk factor for delirium .…”

“…Many other studies have suggested preoperative cognitive impairment as a risk factor. 3,[6][7][8]14,16,29 A history of CVD is a wellknown risk factor for delirium. [3][4][5][6][7] In addition, hypoalbuminemia is also a well-known risk factor for dementia in hospitalized patients, including those undergoing surgery, in many studies.…”

“…The incidence of delirium is affected by multiple factors. Known risk factors for delirium include age, pre‐existing cognitive impairment and alcohol abuse, comorbidity, the environment, and medical care including an indwelling urethral catheter . In urinary tract surgery, including minimally invasive and transurethral surgery, a prolonged indwelling urethral catheter is often required, and this might be a potential risk for postoperative delirium.…”

C‐reactive protein for risk prediction of post‐operative delirium and post‐operative neurocognitive disorder

“…Post‐operative delirium (POD) is a costly complication associated with increased morbidity, longer hospital admission, reduced quality of life and a 2.4‐fold increase in 1‐year mortality in older surgical patients . As one of the most common post‐operative complications in the elderly, POD is seen in 21% of patients after orthopedic surgery, in 39% after vascular and cardiac surgery and in up to 87% in the critically ill . Post‐operative neurocognitive disorder (NCD), also called post‐operative cognitive dysfunction (‘POCD’), is often seen as an adverse outcome related to POD, although research on this association has produced conflicting results .…”

Delir – ein evidenzbasierter Überblick

“…Postoperatives Delir (früher syn. Durchgangssyndrom) Bis zu 40 % der PatientInnen nach größeren Operationen entwickeln ein Delir [1,3]. Die Wahrscheinlichkeit für ein POD steigt mit der Länge und Invasivität der Operation, dem Volumen an transfundiertem Blut, ist bei offenen Operationen höher als bei endovaskulären Operationen Die Wirkung von Cholinesteraseinhibitoren, die zur Behandlung der Alzheimer Demenz eingesetzt werden, ist in der Delirtherapie nicht nachgewiesen.…”