Postoperative delirium following vascular surgery

Introduction: Postoperative delirium is a common psychic disturbance occurr ing acutely after various surgical procedures and typically presenting with a fluctuating course. These patients' recovery takes longer: In this study we analyze the incidence of postoperative delirium in patients undergoing vascular surgery and try to identify risk factors for its development. Methods: Patients undergoing elective arterial operations were included. Th eir medical history, the specific vascular diagnosis and operation performe d,the medication and laboratory data were monitored. Additionally the patie nts were preoperatively interviewed by a psychiatrist. Intraoperatively the drugs, infusions, possible transfusions, blood gases and pressures were mo nitored, as were the times of surgery and anesthesia. Postoperatively patie nts were seen daily by the psychiatrist and the surgeon for at least 7 days . Postoperative delirium was diagnosed according to DSM IV criteria, and mi ld, moderate and severe delirium were distinguished. Results: Fifty-four patients entered the study. Twenty-one (38.9%) develope d post operative delirium (11 mild, 2 moderate, 8 severe). Patients with ao rtic operations developed delirium more frequently than those with non-aort ic procedures (55.5 vs 22.2%, n=27 each). Some preexisting diseases (hearin g disturbance) increased the probability of postoperative delirium, while a ge was not identified as a risk factor. General psychopathological and depr essive disturbances increased the likelihood of postoperative delirium. Pat ients who had a severe intraoperative course developed postoperative deliri um more frequently. This was not seen in the absolute time of surgery or an esthesia nor in the intraoperative development of blood pressure or intraar terial gases, which did not differ between patients with and without postop erative delirium. More reliable parameters were an increased intraoperative need for crystalloid volume, intra - or postoperatively decreased hemoglob in values (Hb <10 g/dl) and the development of acidosis that had to be trea ted. Patients with delirium had serious complications more often (8/21=38.1 % vs 6/33=18.2%) and needed Intensive fare treatment longer (2.7 vs 2.1 day s, only aortic surgery 3.2 vs 2.4 days). Conclusions: Postoperative delirium after Vascular surgery is frequent. Pat ients undergoing aortic surgery, with specific concomittant medical disease , psychopathological disturbances and a severe intraoperative course, are a t risk of developing postoperative delirium.