PURPOSE: 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.