Delirium following vascular surgery: increased incidence with preoperative β-blocker administration

Katznelson, Rita; Djaiani, George; Mitsakakis, Nicholas; Lindsay, Thomas F.; Tait, Gordon; Friedman, Zeev; Wąsowicz, Marcin; Beattie, W. Scott

doi:10.1007/s12630-009-9148-0

Cited by 65 publications

(60 citation statements)

References 47 publications

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“…[6][7][8][9]13 Using an administrative database as the only source of identification of postoperative delirium could considerably underestimate the real incidence rates 14 and lead to conclusions that might conflict with the studies based on validated screening tests for postoperative delirium. 15,16 It is likely that the discrepancy in delirium rates between our two databases is based on the practice and methodology of establishing the diagnosis of delirium. It could be a reflection of inadequate data abstraction, poor communication among the care team, and/or incomplete charting by physicians.…”

Section: Discussionmentioning

confidence: 99%

Hospital administrative database underestimates delirium rate after cardiac surgery

Katznelson

Djaiani

Tait

et al. 2010

Can J Anesth/J Can Anesth

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Purpose Administrative electronic databases are highly specific for postoperative complications, but they lack sensitivity. The objective of this study was to determine the incidence of delirium after cardiac surgery using a targeted prospectively collected dataset and to compare the findings with the incidence of delirium in the same cohort of patients identified in a hospital administrative database. Methods Following Research Ethics Board approval, we compared delirium rates in a prospectively collected data research database with delirium rates in the same cohort of patients in an administrative hospital database where delirium was identified from codes entered by coding and abstracting staff. Every 12 hr postoperatively, delirium was assessed with a Confusion Assessment Method in the Intensive Care Unit. The administrative database contained the International Classification of Diseases version 10 (ICD-10) codes for patient diagnoses. The ICD-10 codes were extracted from the administrative database for each patient in the research database and were checked for the presence of the ICD-10 code for delirium. Results Data from a cohort of 1,528 patients were analyzed. Postoperative delirium was identified in 182 (11.9%) patients (95% confidence interval [CI], 10.3-13.5%) in the research dataset and 46 (3%) patients (95% CI, 2.2-3.8%) in the administrative dataset (P \ 0.001). Thirteen (0.85%) patients who were coded for delirium in the administrative database were not identified in the research dataset. The median onset of postoperative delirium in these patients was significantly delayed (4 [3-9] days) compared with patients identified by both datasets (2 [1-9] days) and compared with patients from the research database only (1 [1-14] days) (P = 0.007). Conclusion Postoperative delirium rates after cardiac surgery are underestimated by the hospital administrative database.

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Section: Discussionmentioning

confidence: 99%

Hospital administrative database underestimates delirium rate after cardiac surgery

Katznelson

Djaiani

Tait

et al. 2010

Can J Anesth/J Can Anesth

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“…We used the same database for the current study as for our previous publication 4 ; however, we extended the current study to an 18-month observation period, thereby increasing the sample size of patients undergoing AAA and TAA procedures. Both elective and emergency cases were eligible for the study.…”

Section: Methodsmentioning

confidence: 99%

“…Identification of delirium was based on the assessments of the NEECHAM scores and the validated chart review instruments, as Endovascular versus open approach to aortic aneurysm repair surgery 557 described previously. 4 Patients with NEECHAM scores \ 25 and/or positive results from a validated chart review were considered to have delirium. Delirium rates were compared in all ages as well as in the subgroups of over 75 yr and under 75 yr.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3] Recently, we reported that older age, history of cerebrovascular accident or transient ischemic attack, depression, preoperative beta-blocker administration, and open aortic reconstruction procedures were associated with a higher risk of postoperative delirium. 4 Rates of delirium after major vascular surgery vary from 30% to more than 50%. [5][6][7][8] In this study, we compared the incidence of postoperative delirium in patients undergoing OPEN aortic aneurysm repair surgery with the incidence in patients undergoing the EVAR approach.…”

Section: Résumémentioning

confidence: 99%

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

Salata

Katznelson

Beattie

et al. 2012

Can J Anesth/J Can Anesth

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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) RésuméObjectif Notre objectif e´tait de comparer la chirurgie de l'ane´vrysme de l'aorte par voie ouverte ou endovasculaire en termes de delirium postope´ratoire. Méthodes Apre`s avoir obtenu l'accord du comited 'e´thique de la recherche de l'e´tablissement, nous avons effectue´une analyse re´trospective de tous les patients ayant subi une re´paration chirurgicale d'un ane´vrysme de l'aorte thoraco-abdominale et abdominale a`l'hôpital ge´ne´ral de Toronto entre juin 2006 et de´cembre 2007. Les patients ont e´te´classe´s dans un groupe OUVERT (OPEN) ou dans le groupe endovasculaire (EVAR) selon le type de chirurgie; la survenue d'un delirium postope´ratoire a e´teŕ echerche´e. L'e´chelle de confusion de NEECHAM et l'instrument valide´d'analyse des dossiers ont e´te´utilise´s Author contributions Scott Beattie and George Djaiani contributed to the conception of the study. Rita Katznelson, Scott Beattie, Jo Carroll, Thomas Lindsay, and George Djaiani contributed to the study design. Scott Beattie took an active part in setting up the inclusion and exclusion criteria. George Djaiani supervised the acquisition, analysis, and interpretation of data. Konrad Salata participated in the analysis of data and drafted the first version of the manuscript. Konrad Salata, Rita Katznelson, and Thomas Lindsay were involved in the interpretation of the data.

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“…'nın (27) yaptığı çalışmada, deliryum gelişen olgularda preoperatif dönemde ß-bloker kullanımının deliryum gelişmeyen olgulara göre daha yüksek olduğu bildirilmiştir. Bunu da ß-blokerlerin beta aderenerjik reseptörlerin yanı sıra deliryum patogenezinde rol alan serotonin duyarlı adenilat siklaz sistemini etkilemesine bağlamışlardır.…”

Section: Dubois Ve Arkunclassified

The Comparison of the Effects of the Off-Pump and Cardiopulmonary By-Pass Techniques Upon Postoperative Delirium at Elective Coronary By-Pass Greft Surgery

Yı́lmaz¹,

Aksun²,

Girgin³

et al. 2013

GKDA Derg

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Delirium following vascular surgery: increased incidence with preoperative β-blocker administration

Cited by 65 publications

References 47 publications

Hospital administrative database underestimates delirium rate after cardiac surgery

Hospital administrative database underestimates delirium rate after cardiac surgery

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

The Comparison of the Effects of the Off-Pump and Cardiopulmonary By-Pass Techniques Upon Postoperative Delirium at Elective Coronary By-Pass Greft Surgery

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