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New aspects of delirium in elderly patients with critical limb ischemia.

van Eijsden WA, Raats JW, Mulder PG, van der Laan L - Clin Interv Aging (2015)

Bottom Line: Perioperative risk factors (age, comorbidity, factors of frailty, operation type, hemoglobulin, and transfusion) were collected and analyzed using logistic regression.After multivariable analysis, only diabetes mellitus (odds ratio [OR] =6.23; 95% confidence interval [CI]: 1.11-52.2; P=0.035) and Short Nutritional Assessment Questionnaire for Residential Care (SNAQ-RC) ≥3 (OR =5.55; 95% CI: 1.07-42.0; P=0.039) was significantly associated with the onset of delirium.This study identified undernourishment and diabetes mellitus as independent risk factors for delirium.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Amphia Hospital, Breda, the Netherlands.

ABSTRACT

Objective: The primary objective was to identify possible risk factors for delirium in patients with critical limb ischemia undergoing surgery. The secondary objective was to study the effect of delirium on complications, the length of hospital stay, health care costs, and mortality.

Methods: All patients 65 years or older with critical limb ischemia undergoing surgery from February 2013 to July 2014 at Amphia Hospital, were included and followed up until December 31, 2014. Delirium was scored using the Delirium Observation Screening Scale (DOSS). Perioperative risk factors (age, comorbidity, factors of frailty, operation type, hemoglobulin, and transfusion) were collected and analyzed using logistic regression. Secondary outcomes were the number of complications, total hospital stay, extra health care costs per delirium, and mortality within 3 months and 6 months of surgery.

Results: We included 92 patients with critical limb ischemia undergoing surgery. Twenty-nine (32%) patients developed a delirium during admission, of whom 17 (59%) developed delirium preoperatively. After multivariable analysis, only diabetes mellitus (odds ratio [OR] =6.23; 95% confidence interval [CI]: 1.11-52.2; P=0.035) and Short Nutritional Assessment Questionnaire for Residential Care (SNAQ-RC) ≥3 (OR =5.55; 95% CI: 1.07-42.0; P=0.039) was significantly associated with the onset of delirium. Delirium was associated with longer hospital stay (P=0.001), increased health care costs, and higher mortality after 6 months (P<0.001).

Conclusion: Delirium is a common adverse event in patients with critical limb ischemia undergoing surgery with devastating outcome in the long term. Most patients developed delirium preoperatively, which indicates the need for early recognition and preventive strategies in the preoperative period. This study identified undernourishment and diabetes mellitus as independent risk factors for delirium.

No MeSH data available.


Related in: MedlinePlus

Survival in relation to the onset of delirium in patients with critical limb ischemia.Abbreviation: DOSS, Delirium Observation Screening Scale.
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f1-cia-10-1537: Survival in relation to the onset of delirium in patients with critical limb ischemia.Abbreviation: DOSS, Delirium Observation Screening Scale.

Mentions: The difference in survival between patients with and without a delirium was tested and illustrated using the Kaplan–Meier method (Figure 1). Overall mortality was higher in the delirium group than in the non-delirium group (log-rank test P<0.0005). Thirty-four percent of the patients with a delirium died within 6 months after surgery in contrast to 8% in the non-delirium group (P=0.005). There was no difference in new admissions to a nursing home between both groups (Table 6).


New aspects of delirium in elderly patients with critical limb ischemia.

van Eijsden WA, Raats JW, Mulder PG, van der Laan L - Clin Interv Aging (2015)

Survival in relation to the onset of delirium in patients with critical limb ischemia.Abbreviation: DOSS, Delirium Observation Screening Scale.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592029&req=5

f1-cia-10-1537: Survival in relation to the onset of delirium in patients with critical limb ischemia.Abbreviation: DOSS, Delirium Observation Screening Scale.
Mentions: The difference in survival between patients with and without a delirium was tested and illustrated using the Kaplan–Meier method (Figure 1). Overall mortality was higher in the delirium group than in the non-delirium group (log-rank test P<0.0005). Thirty-four percent of the patients with a delirium died within 6 months after surgery in contrast to 8% in the non-delirium group (P=0.005). There was no difference in new admissions to a nursing home between both groups (Table 6).

Bottom Line: Perioperative risk factors (age, comorbidity, factors of frailty, operation type, hemoglobulin, and transfusion) were collected and analyzed using logistic regression.After multivariable analysis, only diabetes mellitus (odds ratio [OR] =6.23; 95% confidence interval [CI]: 1.11-52.2; P=0.035) and Short Nutritional Assessment Questionnaire for Residential Care (SNAQ-RC) ≥3 (OR =5.55; 95% CI: 1.07-42.0; P=0.039) was significantly associated with the onset of delirium.This study identified undernourishment and diabetes mellitus as independent risk factors for delirium.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Amphia Hospital, Breda, the Netherlands.

ABSTRACT

Objective: The primary objective was to identify possible risk factors for delirium in patients with critical limb ischemia undergoing surgery. The secondary objective was to study the effect of delirium on complications, the length of hospital stay, health care costs, and mortality.

Methods: All patients 65 years or older with critical limb ischemia undergoing surgery from February 2013 to July 2014 at Amphia Hospital, were included and followed up until December 31, 2014. Delirium was scored using the Delirium Observation Screening Scale (DOSS). Perioperative risk factors (age, comorbidity, factors of frailty, operation type, hemoglobulin, and transfusion) were collected and analyzed using logistic regression. Secondary outcomes were the number of complications, total hospital stay, extra health care costs per delirium, and mortality within 3 months and 6 months of surgery.

Results: We included 92 patients with critical limb ischemia undergoing surgery. Twenty-nine (32%) patients developed a delirium during admission, of whom 17 (59%) developed delirium preoperatively. After multivariable analysis, only diabetes mellitus (odds ratio [OR] =6.23; 95% confidence interval [CI]: 1.11-52.2; P=0.035) and Short Nutritional Assessment Questionnaire for Residential Care (SNAQ-RC) ≥3 (OR =5.55; 95% CI: 1.07-42.0; P=0.039) was significantly associated with the onset of delirium. Delirium was associated with longer hospital stay (P=0.001), increased health care costs, and higher mortality after 6 months (P<0.001).

Conclusion: Delirium is a common adverse event in patients with critical limb ischemia undergoing surgery with devastating outcome in the long term. Most patients developed delirium preoperatively, which indicates the need for early recognition and preventive strategies in the preoperative period. This study identified undernourishment and diabetes mellitus as independent risk factors for delirium.

No MeSH data available.


Related in: MedlinePlus