The effects of age, delirium and frailty on outcome after vascular surgery

The life expectancy of the western population is increasing. As a result of improved surgical techniques, more elderly patients are suitable for surgery, especially vascular surgery. Frailty is a combination of illness, psychosocial stressors and subclinical burden, and frail patients are at increased risk for complications. The aim of this thesis was to investigate which factors contribute to impaired outcome after vascular surgery. In chapter 2, we investigated stent-related complications after endovascular aneurysm repair (EVAR) in octogenarians. In our cohort, they had the same amount of postoperative complications compared to younger patients, but with fewer re-interventions. The amount of aneurysm related deaths however, did not differ between groups. Therefore, an adjusted follow-up scheme could be considered. In chapter 3 and 4 we focussed on postoperative delirium (POD). In both a meta-analysis and our own cohort, we determined the incidence and specific risk factors for POD. The incidence ranged from 5-39% in the literature. Multivariate regression analysis revealed preoperative cognitive impairment, open aortic surgery or amputation surgery, smoking, hypertension and age >80 years as risk factors in our own cohort. In chapter 5, we found that frailty was significantly associated with the amount and severity of postoperative complications. Also, we found that some domains of frailty had a more pronounced impact than others. Chapter 6 focussed on outcome after carotid endarterectomy (CEA). We found that the presence of metabolic syndrome had no negative effect.