Drug Treatment for Patients with Postoperative Delirium and Consultation-Liaison Psychiatry in Japan: A Retrospective Observational Study of a Nationwide Hospital Claims Database

Abstract

A BSTRA CT BACKGROUND Delirium is the most commonly experienced disorder in consultation liaisons. There are currently research and guidelines in Japan for delirium treatment. Still, there is no retrospective observational study of consultation-liaison psychiatry (CLP) and antipsychotic-centered drugs. This study aims to examine CLP's effectiveness and drug treatment. METHODS Using a Japanese national inpatient database of 2016 and 2017, we investigated the presence or absence of CLP for the treatment of delirium in postoperative delirium patients, the status of drug selection, delirium days, and the average days from surgery to discharge. We examined factors affecting days from surgery to discharge using multiple linear regression analysis. RESULTSThis study was classified into a CLP group (n = 1,142) and a non-CLP group (n = 11,355). The days from surgery to discharge in the CLP and non-CLP groups was 16.7 and 17.1, respectively (p = 0.3613). There was a significant difference in the delirium days between the CLP and non-CLP groups (8.9 vs. 7.4; p < 0.00001). Haloperidol infusion was frequently used between the days from surgery to first day of delirium. It was prescribed less often than other oral drugs. Multiple regression analysis identified an association between age, men, CCI1-2, CCI ≥3, number of drugs used, days from surgery to first day of delirium, and early CLP (0-2days) with days from surgery to discharge. CONCLUSIONSWe investigated the effectiveness of CLP and the actual conditions of pharmacotherapy for postoperative delirium. Our findings suggest that early CLP may be associated with shorter days from surgery to discharge.

Demographic and clinical characteristics of patients with delirium: analysis of a nationwide Japanese medical database

“…The outcomes are similar to those from a recent database study in Japan, where haloperidol infusion was the most frequently used treatment in postoperative patients with delirium. 17 These results are also consistent with those of a questionnaire-based cross-sectional study in which more than two-thirds of Japanese experts recommended intravenous haloperidol as the initial drug (if an intravenous line was placed during hospitalisation) and atypical oral antipsychotics such as risperidone or quetiapine as initial oral drugs for hyperactive delirium. 42 Risperidone solution and olanzapine orodispersible tablets could be useful for patients who have difficulties in taking medicines.…”

“…A recent study employing a Japanese national inpatient database used the daily nursing necessity score (dangerous behaviour or misunderstanding of nursing instructions) as the criterion of delirium, but reported a prevalence of delirium of approximately 1% (n=21 182) among 2 070 000 postoperative patients. 17 The results of the present study show the feasibility of using administrative databases for identifying patients with delirium in an acute care hospital setting in Japan.…”

“…17 18 A limited number of studies have examined the characteristics of patients experiencing delirium based on a medical database. [17][18][19][20][21][22][23][24][25] This is because identification of delirium through a medical database is quite challenging, given the inconsistent and poor documentation of records. 26 Moreover, the identification of delirium requires bedside cognitive assessments and application of validated diagnostic tools such as the Confusion Assessment Method 27 or the Diagnostic and Statistical Manual of Mental Disorders criteria.…”

“…16 However, few studies have quantitatively investigated the use of antipsychotics for the treatment of patients with delirium in real-world clinical practice in Japan. 17 18 …”

Comparing the effects of peripheral nerve block and general anesthesia with general anesthesia alone on postoperative delirium and complications in elderly patients: a retrospective cohort study using a nationwide database

“…The primary outcome was postoperative delirium from the first postoperative day to the day of discharge. Postoperative delirium was defined as a status requiring newly prescribed antipsychotic drugs (haloperidol, risperidone, quetiapine, olanzapine),20 or as newly status given the code of a reimbursable disease (ICD-10: F05) after the date of surgery. In other words, we defined the code as delirium due to known physiological condition after the surgery.…”