Delirium Associated Adverse Events And Resource Use After Infrainguinal Lower Extremity Bypass

Abstract

INTRODUCTION AND OBJECTIVES Delirium is common yet often underdiagnosed following vascular surgery. Infrainguinal bypass surgery patients are at particular risk for delirium, yet delirium's burden on other perioperative outcomes and resource utilization remains unclear. This study's objective was to identify delirium predictors and associated resource utilization. METHODS This single center retrospective analysis included all infrainguinal bypass cases from 2012-2020. The primary outcome was delirium development and severity. Secondary outcomes included length of stay, non-home discharge, readmission at 30 and 90 days, and survival. Regression analysis evaluated delirium risk factors and delirium's association with 2 year survival. RESULTS Overall, 420 patients underwent infrainguinal bypass of whom 115 (26%) developed postoperative delirium. Individuals with delirium were older, more likely to be women and have non-elective surgery (all P<0.05). On multivariable analysis, independent delirium predictors included age, CLTI, and non-elective procedure (Table 1). Consultations were performed in 25 cases (23%), 13 (52%) being to pharmacists, and only 4 (16%) resulted in recommendations. The average length of stay for the delirium group was higher (17 days vs 9 days; P<.001). Delirium was associated with increased non-home discharge (61.8% vs 22.1%; P<.001) and 90-day mortality (7.6% vs 2.9%; P=.033). Survival at 2 years was lower in those with delirium (89% vs 75%; P<.001). On cox multivariable analysis over 2 years, delirium was independently associated with poor survival (HR=2.0; 95% CI=1.15-3.38; P=0.014). CONCLUSIONS Delirium is associated with adverse post-operative outcomes and increased resource utilization, including increased hospital length of stay, non-home discharge, and 2-year mortality. Future studies should evaluate the role of routine multidisciplinary care for high-risk patients to improve perioperative outcomes for vulnerable older adults undergoing lower extremity infrainguinal bypass. Delirium is common yet often underdiagnosed following vascular surgery. Infrainguinal bypass surgery patients are at particular risk for delirium, yet delirium's burden on other perioperative outcomes and resource utilization remains unclear. This study's objective was to identify delirium predictors and associated resource utilization. This single center retrospective analysis included all infrainguinal bypass cases from 2012-2020. The primary outcome was delirium development and severity. Secondary outcomes included length of stay, non-home discharge, readmission at 30 and 90 days, and survival. Regression analysis evaluated delirium risk factors and delirium's association with 2 year survival. Overall, 420 patients underwent infrainguinal bypass of whom 115 (26%) developed postoperative delirium. Individuals with delirium were older, more likely to be women and have non-elective surgery (all P<0.05). On multivariable analysis, independent delirium predictors included age, CLTI, and non-elective procedure (Table 1). Consultations were performed in 25 cases (23%), 13 (52%) being to pharmacists, and only 4 (16%) resulted in recommendations. The average length of stay for the delirium group was higher (17 days vs 9 days; P<.001). Delirium was associated with increased non-home discharge (61.8% vs 22.1%; P<.001) and 90-day mortality (7.6% vs 2.9%; P=.033). Survival at 2 years was lower in those with delirium (89% vs 75%; P<.001). On cox multivariable analysis over 2 years, delirium was independently associated with poor survival (HR=2.0; 95% CI=1.15-3.38; P=0.014). Delirium is associated with adverse post-operative outcomes and increased resource utilization, including increased hospital length of stay, non-home discharge, and 2-year mortality. Future studies should evaluate the role of routine multidisciplinary care for high-risk patients to improve perioperative outcomes for vulnerable older adults undergoing lower extremity infrainguinal bypass.