Top

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

01-06-2012 | Reports of Original Investigations

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

Authors: Konrad Salata, (H)BHSc, Rita Katznelson, MD, W. Scott Beattie, MD, PhD, Jo Carroll, RN, Thomas F. Lindsay, MD, George Djaiani, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 6/2012

Abstract

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) yr, and they had shorter duration of surgery, 150 [119, 180] min vs 200 [165, 260] min, respectively, P < 0.0001. Postoperative delirium was present in 43 (29%) patients in the OPEN group and 14 (13%) patients in the EVAR group (95% confidence interval [CI], 22 to 36 vs 95% CI, 7 to 19, respectively; P = 0.003). Hospital length of stay was 8.3 [6.6, 13.4] days in the OPEN group and 4.5 [3.1, 6.4] days in the EVAR group, P < 0.0001.

Conclusions

Perioperative management of patients undergoing endovascular aortic aneurysm repair was associated with lower rates of delirium after surgery than that of patients undergoing open aortic aneurysm repair.

Rosen SF, Clagett GP, Valentine RJ, Jackson M, Modrall JG, McIntyre KE. Transient advanced mental impairment: an underappreciated morbidity after aortic surgery. J Vasc Surg 2002; 35: 376-81.PubMedCrossRef

Bohner H, Friedrichs R, Habel U, Muller EE, Sandmann W, Schneider F. Delirium increases morbidity and length of stay after vascular surgery operations. Results of a prospective study (German). Chirurg 2003; 74: 931-6.PubMedCrossRef

Franco K, Litaker D, Locala J, Bronson D. The cost of delirium in the surgical patient. Psychosomatics 2001; 42: 68-73.PubMedCrossRef

Katznelson R, Djaiani G, Mitsakakis N, et al. Delirium following vascular surgery: increased incidence with preoperative beta-blocker administration. Can J Anesth 2009; 56: 793-801.PubMedCrossRef

Balasundaram B, Holmes J. Delirium in vascular surgery. Eur J Vasc Endovasc Surg 2007; 34: 131-4.PubMedCrossRef

Benoit AG, Campbell BI, Tanner JR, et al. Risk factors and prevalence of perioperative cognitive dysfunction in abdominal aneurysm patients. J Vasc Surg 2005; 42: 884-90.PubMedCrossRef

Bohner H, Hummel TC, Habel U, et al. Predicting delirium after vascular surgery: a model based on pre- and intraoperative data. Ann Surg 2003; 238: 149-56.PubMed

Schneider F, Bohner H, Habel U, et al. Risk factors for postoperative delirium in vascular surgery. Gen Hosp Psychiatry 2002; 24: 28-34.PubMedCrossRef

Neelon VJ, Champagne MT, Carlson JR, Funk SG. The NEECHAM confusion scale: construction, validation, and clinical testing. Nurs Res 1996; 45: 324-30.PubMedCrossRef

10.

Koebrugge B, van Wensen RJ, Bosscha K, Dautzenberg PL, Koning OH. Delirium after emergency/elective open and endovascular aortoiliac surgery at a surgical ward with a high-standard delirium care protocol. Vascular 2010; 18: 279-87.PubMedCrossRef

11.

Greenhalgh RM, Brown LC, Powell JT, et al. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010; 362: 1863-71.PubMedCrossRef

12.

EVAR Trial Participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005; 365: 2179-86.CrossRef

13.

De Bruin JL, Baas AF, Buth J, et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 2010; 362: 1881-9.PubMedCrossRef

14.

Mani K, Lees T, Beiles B, et al. Treatment of abdominal aortic aneurysm in nine countries 2005–2009: A Vascunet Report. Eur J Vasc Endovasc Surg 2011; 42: 598-607.PubMedCrossRef

15.

Sanders RD. Hypothesis for the pathophysiology of delirium: Role of baseline brain network connectivity and changes in inhibitory tone. Med Hypotheses 2011; 77: 140-3.PubMedCrossRef

Title: Endovascular versus open approach to aortic aneurysm repair surgery: rates of postoperative delirium
Authors: Konrad Salata, (H)BHSc
Rita Katznelson, MD
W. Scott Beattie, MD, PhD
Jo Carroll, RN
Thomas F. Lindsay, MD
George Djaiani, MD
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 6/2012
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-012-9695-7

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2012

Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development

Venoarterial extracorporeal membrane oxygenation support for two patients after pulmonary thromboendarterectomy

Cardiac arrest in the operating room requiring prolonged resuscitation

Perioperative statin therapy: understanding the evidence in a Bayesian context

Clinical Ambulatory Anesthesia

Anti-inflammatory effects of perioperative statin therapy