The effect of preoperative cognitive impairment and type of vascular surgery procedure on postoperative delirium with associated cost implications

Styra, Rima; Larsen, Elisabeth; Dimas, Michelle; Baston, Dorina; Elgie-Watson, Jeanne; Flockhart, Linda; Lindsay, Thomas F.

doi:10.1016/j.jvs.2018.05.001

Cited by 39 publications

(34 citation statements)

References 40 publications

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“…Delirium is a concern in the elderly; evidence suggests increased risk only in MOCA of less than 15; this patient has MOCA of 23. 17 Age of more than 70 years correlates with only a small increase in major perioperative complications (7.5% vs 4.8%). 18 The EUROSTAR study demonstrated that EVAR patients return to preoperative status sooner.…”

Section: Discussionmentioning

confidence: 93%

Endovascular abdominal aortic aneurysm repair in a centenarian

Bellamkonda

Kim

Rosenthal

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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As the general population ages, there will be an increasing number of vascular patients in their 90s and older. However, geriatric patients have historically been turned down for abdominal aortic aneurysm repair despite high aneurysm-related mortality in the unrepaired. Herein, we describe the perioperative considerations and the successful, uncomplicated operative course of a 100-year-old woman who underwent an elective endovascular aortic aneurysm repair for an expanding 5.3-cm abdominal aortic aneurysm. Given a suitable patient, there is acceptable risk profile of an endovascular approach, even in centenarians.

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Section: Discussionmentioning

confidence: 93%

Endovascular abdominal aortic aneurysm repair in a centenarian

Bellamkonda

Kim

Rosenthal

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…As patients with pre-existing cognitive impairment are more likely to develop postoperative delirium (Styra et al, 2019), it will be important to determine whether microglia in neurodegenerative disorders are amenable to peri-operative manipulations that prevent its activation and the onset of postoperative delirium.…”

Section: Potential Developments In the Fieldmentioning

confidence: 99%

The Role of Microglia in Perioperative Neuroinflammation and Neurocognitive Disorders

Saxena

Kruys²,

Vamecq

et al. 2021

Front. Aging Neurosci.

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The aseptic trauma of peripheral surgery activates a systemic inflammatory response that results in neuro-inflammation; the microglia, the resident immunocompetent cells in the brain, are a key element of the neuroinflammatory response. In most settings microglia perform a surveillance role in the brain detecting and responding to “invaders” to maintain homeostasis. However, microglia have also been implicated in producing harm possibly by changing its phenotype from its beneficial, anti-inflammatory state (termed M2) into an injurious pro-inflammatory state (termed M1); it is likely that there are intermediates states between these polar phenotypes and some consider that a gradient exists with a number of intermediates, rather than a strict dichotomy between M1 and M2. In the pro-inflammatory phenotypes, microglia can disrupt synaptic plasticity such as long- term potentiation that can result in disorders of learning and memory of the type observed in Peri-operative Neurocognitive Disorders. Therefore, investigators have sought strategies to prevent microglia from provoking this adverse event in the perioperative period. In preclinical studies microglia can be depleted by removing trophic factors required for its maintenance; subsequent repopulation with a more beneficial microglial phenotype may result in memory enhancement, improved sensory motor function, as well as suppression of neuroinflammatory and oxidative stress pathways. Another approach consists of preventing microglial activation using the non-specific P38 MAP kinase blockers such as minocycline. Perhaps a more physiologic approach is the use of inhibitors of potassium (K+) channels that are required to convert the microglia into an active state. In this context the specific K+ channels that are implicated are termed Kv1.3 and KCa3.1 and high selective inhibitors for each have been developed. Data are accumulating demonstrating the utility of these K+ channel blockers in preventing Perioperative Neurocognitive Disorders.

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“…Delirium is a neuropsychiatric disorder that is characterized by acute and fluctuating changes in baseline attention, awareness, and cognition 1 . Postoperative delirium (POD) is defined by a disturbance of consciousness that is accompanied by impaired attention or inability to focus that cannot be explained by a pre-existing or evolving neurocognitive disorder 1 , 2 . POD is well known to be associated with prolonged hospital stay and medical morbidities.…”

Section: Introductionmentioning

confidence: 99%

“…POD is well known to be associated with prolonged hospital stay and medical morbidities. It also increases medical costs 2 – 4 .…”

Section: Introductionmentioning

confidence: 99%

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

Kang

Jeon

et al. 2021

Sci Rep

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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.

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The effect of preoperative cognitive impairment and type of vascular surgery procedure on postoperative delirium with associated cost implications

Cited by 39 publications

References 40 publications

Endovascular abdominal aortic aneurysm repair in a centenarian

Endovascular abdominal aortic aneurysm repair in a centenarian

The Role of Microglia in Perioperative Neuroinflammation and Neurocognitive Disorders

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

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