Transient advanced mental impairment: An underappreciated morbidity after aortic surgery

Rosen, Scott F.; Clagett, G. Patrick; Valentine, R. James; Jackson, Mark R.; Modrall, J. Gregory; McIntyre, Kenneth E.

doi:10.1067/mva.2002.119233

Cited by 32 publications

(41 citation statements)

References 30 publications

(48 reference statements)

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“…In contrast to previous reports, we did not use age [60 as an inclusion criterion, and we did not limit the list of vascular procedures to open aortic reconstructive and peripheral bypass surgery. [3][4][5]47 In order to reduce bias, we also excluded all patients undergoing carotid surgery from the analysis. Patients with uncomplicated carotid surgery usually had length of stay\48 h and therefore did not meet our inclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

“…Delirium is a common and well-recognized complication after vascular surgery that affects over 30% of patients [1][2][3][4] and is associated with prolonged length of stay, 5 increased health care costs, 6 and higher morbidity and mortality. [7][8][9][10] Furthermore, patients with delirium are more likely to be discharged to either intermediate-or long-term care facilities, 5 increasing the primary admission health care costs to the community.…”

mentioning

confidence: 99%

“…[7][8][9][10] Furthermore, patients with delirium are more likely to be discharged to either intermediate-or long-term care facilities, 5 increasing the primary admission health care costs to the community.…”

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confidence: 99%

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

Katznelson

Djaiani

Mitsakakis

et al. 2009

Can J Anesth/J Can Anesth

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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.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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

Katznelson

Djaiani

Mitsakakis

et al. 2009

Can J Anesth/J Can Anesth

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“…As the management of surgical and systemic postoperative complications in these patients is a challenge, the postoperative course may further be complicated by delirium. [4][5][6][7] Specific research has been performed to describe and understand the risk factors that favor the development of a postoperative delirium. Known risk factors include poor preoperative functional status, cognitive impairment, depression, alcoholism, vascular disease, comorbidity, and older age.…”

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confidence: 99%

Postoperative Course After Emergency Colorectal Surgery for Secondary Peritonitis in the Elderly Is Often Complicated by Delirium

Engelberger

Zürcher

Schuld

et al. 2012

International Surgery

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Postoperative delirium, morbidity, and mortality in our elderly patients with secondary perionitis of colorectal origin is described. This is a chart-based retrospective analysis of 63 patients who were operated on at the University Hospital Basel from April 2001 to May 2004. Postoperative delirium occurred in 33%. Overall morbidity was 71.4%. Surgery-related morbidity was 43.4%. Mortality was 14.4%. There was no statistical significance between delirium, morbidity and mortality (P = 0.279 and P = 0.364). There was no statistically significant correlation between the analyzed scores (American Society of Anesthesiologists classification, Mannheimer Peritonitis Index, Acute Physiology and Chronic Health Evaluation score II, physiological and operative surgical severity and enumeration of morbidity and mortality score' or short 'cr-POSSUM') and postoperative delirium, morbidity or mortality. Postoperative delirium occurred in one-third of the patients, who seem to have a trend to higher morbidity. Even if the different scores already had proven to be predictive in terms of morbidity and mortality, they do not help the risk stratification of postoperative delirium, morbidity, or mortality in our collective population.

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“…Delirium is a serious postoperative complication associated with higher postoperative morbidity and mortality, prolonged intensive care unit and hospital length of stay (LOS), as well as increased healthcare costs. [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%.…”

Section: Résumémentioning

confidence: 99%

Endovascular versus open approach to aortic aneurysm repair surgery: rates of postoperative delirium

Salata

Katznelson

Beattie

et al. 2012

Can J Anesth/J Can Anesth

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Purpose Our objective was to compare open and endovascular aortic aneurysm repair with respect to postoperative delirium. Methods After Institutional Ethics Review Board approval, we conducted a retrospective review of all patients who underwent abdominal and thoraco-abdominal aortic aneurysm repair surgery at Toronto General Hospital during June 2006 to December 2007. Patients were classed into either the OPEN or the endovascular (EVAR) group based on the type of surgery and were assessed for the presence of delirium after surgery. The NEECHAM Confusion Scale and the validated chart review instrument were used for diagnosis of delirium. Patients with dementia and/or abnormal levels of consciousness preoperatively were excluded. Results There were 256 patients included in the study, 149 (58%) in the OPEN group and 107 (42%) in the EVAR group. Patients in the EVAR group were considerably older, 74 (10) yr vs 68 (9) RésuméObjectif Notre objectif e´tait de comparer la chirurgie de l'ane´vrysme de l'aorte par voie ouverte ou endovasculaire en termes de delirium postope´ratoire. Méthodes Apre`s avoir obtenu l'accord du comited 'e´thique de la recherche de l'e´tablissement, nous avons effectue´une analyse re´trospective de tous les patients ayant subi une re´paration chirurgicale d'un ane´vrysme de l'aorte thoraco-abdominale et abdominale a`l'hôpital ge´ne´ral de Toronto entre juin 2006 et de´cembre 2007. Les patients ont e´te´classe´s dans un groupe OUVERT (OPEN) ou dans le groupe endovasculaire (EVAR) selon le type de chirurgie; la survenue d'un delirium postope´ratoire a e´teŕ echerche´e. L'e´chelle de confusion de NEECHAM et l'instrument valide´d'analyse des dossiers ont e´te´utilise´s Author contributions Scott Beattie and George Djaiani contributed to the conception of the study. Rita Katznelson, Scott Beattie, Jo Carroll, Thomas Lindsay, and George Djaiani contributed to the study design. Scott Beattie took an active part in setting up the inclusion and exclusion criteria. George Djaiani supervised the acquisition, analysis, and interpretation of data. Konrad Salata participated in the analysis of data and drafted the first version of the manuscript. Konrad Salata, Rita Katznelson, and Thomas Lindsay were involved in the interpretation of the data.

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Transient advanced mental impairment: An underappreciated morbidity after aortic surgery

Abstract: These data show that TAMI is prevalent among patients undergoing aortic reconstruction and is associated with dramatically increased morbidity and postoperative hospitalization rates.

Cited by 32 publications

References 30 publications

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

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

Postoperative Course After Emergency Colorectal Surgery for Secondary Peritonitis in the Elderly Is Often Complicated by Delirium

Endovascular versus open approach to aortic aneurysm repair surgery: rates of postoperative delirium

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