Type of Anesthesia and Postoperative Delirium After Vascular Surgery

Ellard, Louise; Katznelson, Rita; Wąsowicz, Marcin; Ashworth, Alan; Carroll, Jo; Lindsay, Thomas F.; Djaiani, George

doi:10.1053/j.jvca.2013.12.003

Cited by 40 publications

(31 citation statements)

References 35 publications

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“…We think that the paravertebral and intercostal blocks received by these patients would have limited additional opioid required to treat pain from the mini‐thoracotomy. We have previously reported that general anaesthesia was not associated with a higher rate of delirium after vascular surgery, compared with regional or local anaesthesia .…”

Section: Discussionmentioning

confidence: 81%

Delirium after transcatheter aortic valve implantation via the femoral or apical route

et al. 2016

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SummaryWe thought that delirium might be less frequent after transcatheter aortic valve implantation via the femoral artery compared with via the cardiac apex. We reviewed 210 patients who underwent transcatheter aortic valve implantation between January 2009 and October 2014. The proportion (95% CI) of patients who suffered delirium in the 3 days after valve implantation were: 10 (3-16%) in 105 patients who had transfemoral implantation; and 35 (25-45%) in 105 patients who had transapical implantation, p = 0.0001. The variables that independently associated with postoperative delirium were age, male sex and the transapical approach. The median (IQR [range]) hospital stay was 7 (5-13 [2-41]) days and 10 (7-15 [2-64]) days, respectively, p = 0.004. Future trials should focus on different perioperative management strategies to reduce delirium rates after transcatheter aortic valve implantation, particularly in older men having implantations via the cardiac apex.

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Section: Discussionmentioning

confidence: 81%

Delirium after transcatheter aortic valve implantation via the femoral or apical route

et al. 2016

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“…The results of the search strategy are reported in Figure 1. Fifteen studies [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] were eligible for inclusion and used to establish the incidence of delirium: eight studies were used to quantify hospital length of stay 16,[19][20][21][24][25][26]28 , eight studies for assessing the association of age with delirium 14,15,17,21,22,[25][26][27] and 10 studies were used in the prognostic factor analysis. 14,15,[17][18][19]21,22,[26][27][28] Three studies were included in the meta-analysis examining age as a prognostic factor for delirium, 15,18,22 and three studies in the meta-analysis examining pre-existing cognitive impairment.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies examined the impact of anaesthetic type on rates of delirium using crude ratios or univariate analysis. 16,21,22 None of these three studies found that general anaesthetic was prognostic of delirium development; however, they did not account for use of sedation, patient comorbidities or type of anaesthesia such as general versus loco-regional anaesthesia. The QUIPS risk of bias score demonstrated a moderate-high risk of bias for confounding and analysis in two of these three studies.…”

Section: Impact Of Anaesthetic Type On Incidence Of Deliriummentioning

confidence: 99%

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

2017

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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.

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“…Interestingly, the choice of regional versus general anesthesia does not appear to affect the likelihood of delirium after surgery [73][74][75]. Recent investigations have focused on whether the depth of anesthesia plays a role.…”

Section: Noncardiac Surgerymentioning

confidence: 99%

Postoperative Delirium: A Review of Risk Factors and Tools of Prediction

Schenning

Deiner

2015

Curr Anesthesiol Rep

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Over one-third of the surgeries in the United States are performed on patients aged 65 and older, and delirium is one of the most common postoperative complications in this population. Postoperative delirium is a heterogeneous disorder, and as such it is not surprising that the reported predisposing and precipitating factors are widely variable. Knowledge of the risk factors that predict postoperative delirium will aid in early identification of patients at highest risk in order to allow targeted use of resources including geriatric consults, specialized units, and nonpharmacologic interventions.

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Type of Anesthesia and Postoperative Delirium After Vascular Surgery

Cited by 40 publications

References 35 publications

Delirium after transcatheter aortic valve implantation via the femoral or apical route

Delirium after transcatheter aortic valve implantation via the femoral or apical route

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

Postoperative Delirium: A Review of Risk Factors and Tools of Prediction

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