title: New aspects of delirium in elderly patients with critical limb ischemia.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, the Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: van Eijsden
authors.affiliation: Department of Surgery, Amphia Hospital, Breda, the Netherlands.
authors.forename: Jelle W
authors.initials: JW
authors.lastname: Raats
authors.affiliation: Amphia Academy, Amphia Hospital, Breda, the Netherlands.
authors.forename: Paul Gh
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: D000368:Aged; D003693:Delirium / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D016330:Frail Elderly; D017048:Health Care Costs; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: amputation; bypass surgery; confusion; costs; frailty; risk factors; vascular surgery