The Impact of Delirium After Cardiac Surgical Procedures on Postoperative Resource Use

Abstract

Background Delirium is a common complication after cardiac surgery and is associated with increased morbidity and mortality. However, whether rigorously-assessed postoperative delirium is associated with increased length of stay in the intensive care unit (LOS-ICU), length of stay (LOS), and hospital charges is not clear. Methods Patients (n=66) undergoing coronary artery bypass and/or valve surgery were enrolled in a nested cohort study. Rigorous delirium assessments were conducted using the Confusion Assessment Method. LOS-ICU and LOS were obtained from the medical record and hospital charges from administrative data reported to the state. Because of the skewed distribution of outcome variables, outcomes were compared using rank-sum tests, as well as median regression incorporating propensity scores. Results Patients who developed delirium (56%) vs. no delirium (43%) had increased median LOS-ICU (75.6 hours [IQR 43.6–136.8] vs. 29.7 hours [IQR 21.7–46.0]; p=0.002), increased median LOS (9 days [IQR 6–16] vs. 7 days [IQR 5–8]; p=0.006), and increased median hospital charges ($51,805 [IQR $44,041-$80,238] vs. $41,576 [IQR $35,748-$43,660]; P=0.002). In propensity score models adjusted for patient and surgical characteristics and complications, the results for LOS-ICU and cost remained highly significant, although the results for LOS were attenuated based on the specific statistical model. Increased severity of delirium was associated with both increased LOS-ICU and charges in a dose-response manner. Conclusions Delirium after cardiac surgery is independently associated with both increased length of stay-ICU and higher hospital charges. Since delirium is potentially preventable, targeted delirium-prevention protocols for high-risk patients may represent an important strategy for quality improvement.

Dynamic cerebral autoregulation: A marker of post-operative delirium?

“…The potential consequences of delirium after cardiac surgery have been reported in several studies (Martin et al, 2012;Saczynski et al, 2012;Otomo et al, 2013;Brown et al, 2016). In agreement with these data, our group of patients with PD had longer duration of mechanical ventilation, prolonged use of drugs such as dobutamine and norepinephrine, with more patients having acute kidney injury, tachyarrhythmia and cardiogenic shock, and the longer lengths of ICU stay.…”

Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit: an early sign of postoperative complications

“…In the current prospective observational study, we chose PACU-D as our primary outcome measure because of its temporal proximity to emergence and its implication as an early marker of POD. 1,52 POD (occurring on or after the first postoperative day) has revealed associations with adverse outcomes, such as increased functional decline up to 1 month after surgery, 53 cognitive decline up to 6 months after surgery, 54 length of ICU 26,55 and hospital stay, 26,55e57 hospital costs, 26,55,57,58 postdischarge institutionalisation, 26,56 30 day hospital readmission, 56 and mortality. 26,59 Our intention was to evaluate whether perioperative EEG features are associated with the development of PACU-D.…”

The 4 ‘A’s test for detecting delirium in acute medical patients: a diagnostic accuracy study

“…Introduction Delirium is associated with increased mortality, reduced quality of life and increased health-care costs. 4,8,62,[194][195][196][197][198][199] As a prerequisite to estimating the cost-effectiveness of a delirium screening tool such as the 4AT, it is necessary to first characterise survival, cost and quality of life in patients with and without a diagnosis of delirium in a current UK population. The objectives of this economic evaluation within the 4AT study were to estimate the observed 12-week cumulative health-care-associated costs in these two groups of patients (delirium or no delirium) in the NHS in the three study sites.…”