The Burden of Postoperative Delirium after Vascular Surgery

Abstract

Postoperative delirium, characterised by an acute onset, a fluctuating course, and an altered level of consciousness and global disturbances of attention, orientation, perception, and sleepeawake cycles, is a common complication after surgical procedures. Its incidence averages 20e40% but can vary from 0% to as high as 73%, and its recognition may be missed by medical providers in up to 50% of cases. Delirium is linked to a reversible impairment of cerebral oxidative metabolism and neurotransmission caused by hypoxia, but its physiopathology remains partly unclear. One hypothesis is that serotonin deficiency resulting from tryptophan depletion and phenylalanine elevation is involved in the pathogenesis of postoperative delirium. Encephalography or other diagnostic measures have demonstrated no specific findings, and most patients completely recover within a few days. However, delirium in surgical patients is associated with multiple medical complications, such as falls, fractures, disruptive behaviour, and incontinence leading to bladder catheterisation and an increased risk for infections. It increases nursing care, length of hospital stay, likelihood of being discharged to a nursing home, and health care costs. Numerous preoperative, intraoperative, and postoperative risk factors for developing postoperative delirium have been identified, with significant differences across studies. The multiple and different factors identified as