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Postoperative delirium occurred in 12.5% of vascular surgery patients, often linked to pain and longer hospital stays. Early detection and management strategies are crucial for better outcomes.

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Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Geriatric Medicine
  • Surgical Critical Care

Background:

  • Postoperative delirium (POD) is a significant concern in surgical patients, particularly in the elderly.
  • Vascular surgery patients are at risk due to complex procedures and potential for hemodynamic instability.

Purpose of the Study:

  • To determine the incidence of POD in vascular surgery patients.
  • To identify perioperative risk factors associated with POD.
  • To assess the impact of POD on hospital length of stay (LOS) and develop a management algorithm.

Main Methods:

  • Prospective evaluation of 56 consecutive vascular surgery patients.
  • Exclusion of patients with pre-existing cognitive or sensory impairments.
  • Pre-anesthetic cognitive assessment using Mini Mental State Examination (MMSE) and intraoperative/postoperative delirium assessment using Confusion Assessment Method (CAM).

Main Results:

  • The overall incidence of POD was 12.5%, predominantly occurring between postoperative days 2 and 5.
  • Patients with POD experienced moderate to severe pain and had a significantly longer median LOS (21 days vs. 7 days).
  • Combined general and regional anesthesia was associated with a lower incidence of POD.

Conclusions:

  • The incidence of POD in this vascular surgery cohort was lower than previously reported.
  • Pain is a significant factor associated with POD, highlighting the need for effective pain management.
  • Early and prolonged preventive and diagnostic measures are necessary, given the delayed onset of delirium. Prolonged LOS associated with POD warrants strategic interventions.