Abstract
Patients with vascular diseases are prone to developing postoperative delirium (POD). Ankle brachial index (ABI) is a non-invasive clinical indicator of lower-extremities peripheral arterial disease (PAD) and has been identified as an indicator of cognitive impairment. We investigated the association between ABI and POD. 683 PAD patients who underwent elective leg arterial bypass surgery between October 1998 and August 2019 were collected for retrospective analysis. Demographic information, comorbidities, preoperative ABI and the Rutherford classification within one month prior to surgery were obtained. POD was assessed using the Confusion assessment method -intensive care unit. Logistic regression and receiver operating characteristics (ROC) curve analysis were used to assess the association between ABI and POD. The mean value of ABI was significantly lower in patients with POD than it was those without POD. Older age, more medical comorbidities, longer length of surgery, decreased ABI, and higher Rutherford class were all significantly associated with POD. The area under ROC (0.74) revealed that ABI below 0.35 was associated with development of POD. Lower preoperative ABI was associated with POD in PAD patients who underwent arterial bypass surgery.
Highlights
Patients with vascular diseases are prone to developing postoperative delirium (POD)
Postoperative delirium (POD) is defined by a disturbance of consciousness that is accompanied by impaired attention or inability to focus that cannot be explained by a pre-existing or evolving neurocognitive d isorder[1,2]
Our study shows that peripheral arterial disease (PAD) patients who subsequently developed POD had a significantly lower preoperative Ankle brachial index (ABI) than did those without POD
Summary
Patients with vascular diseases are prone to developing postoperative delirium (POD). Ankle brachial index (ABI) is a non-invasive clinical indicator of lower-extremities peripheral arterial disease (PAD) and has been identified as an indicator of cognitive impairment. Lower preoperative ABI was associated with POD in PAD patients who underwent arterial bypass surgery. The risk factors of POD after vascular surgeries have been studied previously, and include the following: hypertension, history of cognitive impairment, history of delirium, open aortic surgery, major amputation surgery, and preoperative anemia[2,4,9,10]. These multifactorial aspects of POD make its management difficult. POD affected short-term cognitive dysfunction, and long-term cognitive impairment in a prospective study of 200 patients who underwent hip surgery[14]
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