title: Current factors of fragility and delirium in vascular surgery.
abstract: BACKGROUND
  Vascular surgery patients are frequently deemed to be in a frail clinical condition and at risk for delirium. Therefore, we evaluated the incidence and independent perioperative risk factors for delirium. In addition, we describe factors on frailty in the various vascular disease groups in current practice.
  
  
  METHODS
  This observational longitudinal study included 206 selected patients who were referred to a vascular surgery ward of a large-sized teaching hospital (Amphia Hospital, Breda, The Netherlands) for critical limb ischemia (n = 80), diabetic foot ulcers (n = 27), abdominal aortic aneurysm (AAA) (n = 62), and carotid surgery (n = 37) between April 2013 and December 2013. Data on factors that characterize frailty were collected. Delirium was scored using the Delirium Observation Screening Scale. Multivariable logistic regression analysis was performed to find independent risk factors for delirium.
  
  
  RESULTS
  Delirium was present in 24% of the critical limb ischemia patients, in 19% of the patients with a diabetic foot ulcer, in 7% of the patients with an AAA, and in 8% of the patients undergoing carotid surgery (P > 0.05). Of the patients with critical limb ischemia and a delirium, 53% were octogenarians. Multivariable stepwise logistic regression analysis revealed that history of delirium and nurse help at patient's home were independently associated with delirium. Patients with critical limb ischemia scored worse on factors related to frailty compared with the other disease groups in our current clinical practice on vascular surgery.
  
  
  CONCLUSIONS
  Delirium is a frequent complication in vascular surgery clinical practice, especially in the elderly. Nurse visits at patients' homes and the Amphia Risk Score for delirium were independent risk factors for delirium in our study population. In this study, we identified patients with critical limb ischemia as the most frail and vulnerable.
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands. Electronic address: JRaats@amphia.nl.
authors.forename: Jelle W
authors.initials: JW
authors.lastname: Raats
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: Chantal C H A
authors.initials: CC
authors.lastname: van Hoof-de Lepper
authors.affiliation: Department of Geriatric Medicine, Amphia Hospital, Breda, The Netherlands; Department of Geriatric Medicine, Nij Smellinghe Hospital, Drachten, The Netherlands.
authors.forename: Maarten Th
authors.initials: MT
authors.lastname: Feitsma
authors.affiliation: Department of Gerontology and Geriatrics, LUMC, Leiden, The Netherlands; Department of Innovation, Amphia Hospital, Breda, The Netherlands.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Meij
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: Gwan H
authors.initials: GH
authors.lastname: Ho
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: Paul G H
authors.initials: PG
authors.lastname: Mulder
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: Lijckle
authors.initials: L
authors.lastname: van der Laan
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D016638:Critical Illness; D003693:Delirium / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D009735:Nursing Homes; D009752:Nutritional Status; D016017:Odds Ratio; D012307:Risk Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*