Highlights
- •Delirium is a neuropsychiatric disorder with serious health consequences and may occur in the perioperative period.
- •Delirium prevention is better than cure.
- •Little research has been performed on delirium preventive strategies in older vascular surgical patients.
- •An approach that addresses multiple risk factors at once, such as a comprehensive geriatric assessment or multimodal prehabilitation, has the potential to be a successful strategy in preventing delirium. However, more research needs to be done in this important topic.
Background
Elderly patients undergoing vascular surgery are at a risk of developing postoperative
delirium, which is associated with high mortality. Delirium prevention is difficult
and is investigated in surgical patients from various specialisms, but little is known
about delirium prevention in vascular surgery. For this reason we performed a systematic
review on strategies for delirium prevention in patients undergoing elective surgery
for peripheral arterial disease or for an aneurysm of the abdominal aorta.
Methods
This systematic review included studies describing strategies for preventing delirium
in patients undergoing elective surgery for peripheral arterial disease or for an
aneurysm of the abdominal aorta. The search was conducted using the keywords ‘vascular
surgery,’ ‘prevention,’ and ‘delirium’ and was last run on October 21, 2021 in the
electronic databases PubMed, MEDLINE, Embase, Web of Science, the Cochrane library,
and Emcare. Risk of bias was assessed using the Cochrane risk of bias tool for randomized
controlled trials and the ROBINS-1 tool for observational studies.
Results
Four studies including 565 patients were included in the systematic review. A significant
decrease in the incidence of delirium was reported by a study investigating the effect
of comprehensive geriatric assessments within patients undergoing surgery for an aneurysm
of the abdominal aorta or lower limb bypass surgery (24% in the control group vs.
11% in the intervention group, P = 0.018) and in the total group of a study evaluating the effect of outpatient clinic
multimodal prehabilitation for patients with an aneurysm of the abdominal aorta (11.7%
in the control group vs. 8.2% in the intervention group, P = 0.043, Odds Ratio = 0.56). A nonsignificant decrease in delirium incidence was
described for patients receiving a multidisciplinary quality improvement at the vascular
surgical ward (21.4% in the control group vs. 14.6% in the intervention group, P = 0.17). The study concerning the impact of the type of anesthesia on delirium in
11 older vascular surgical patients, of which 3 developed delirium, did not differentiate
between the different types of anesthesia the patients received.
Conclusions
Despite the high and continuous increasing incidence of delirium in the growing elderly
vascular population, little is known about effective preventive strategies. An approach
to address multiple risk factors simultaneously seems to be promising in delirium
prevention, whether through multimodal prehabilitation or comprehensive geriatric
assessments. Several strategies including prehabilitation programs have been proven
to be successful in other types of surgery and more research is required to evaluate
effective preventive strategies and prehabilitation programs in vascular surgical
patients.
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Article info
Publication history
Published online: April 20, 2022
Accepted:
April 3,
2022
Received in revised form:
March 29,
2022
Received:
January 31,
2022
Footnotes
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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