title: Endovascular versus open approach to aortic aneurysm repair surgery: rates of postoperative delirium.
abstract: OBJECTIVE
  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) yr, and they had shorter duration of surgery, 150 [119, 180] min vs 200 [165, 260] min, respectively, P < 0.0001. Postoperative delirium was present in 43 (29%) patients in the OPEN group and 14 (13%) patients in the EVAR group (95% confidence interval [CI], 22 to 36 vs 95% CI, 7 to 19, respectively; P = 0.003). Hospital length of stay was 8.3 [6.6, 13.4] days in the OPEN group and 4.5 [3.1, 6.4] days in the EVAR group, P < 0.0001.
  
  
  CONCLUSIONS
  Perioperative management of patients undergoing endovascular aortic aneurysm repair was associated with lower rates of delirium after surgery than that of patients undergoing open aortic aneurysm repair.
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Eaton North 3-453, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
authors.forename: Konrad
authors.initials: K
authors.lastname: Salata
authors.forename: Rita
authors.initials: R
authors.lastname: Katznelson
authors.forename: W Scott
authors.initials: WS
authors.lastname: Beattie
authors.forename: Jo
authors.initials: J
authors.lastname: Carroll
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lindsay
authors.forename: George
authors.initials: G
authors.lastname: Djaiani
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D003693:Delirium / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013997:Time Factors