TY - JOUR
T1 - The Impact of Delirium after Cardiac Surgical Procedures on Postoperative Resource Use
AU - Brown, Charles H.
AU - Laflam, Andrew
AU - Max, Laura
AU - Lymar, Daria
AU - Neufeld, Karin J.
AU - Tian, Jing
AU - Shah, Ashish S.
AU - Whitman, Glenn J.
AU - Hogue, Charles W.
N1 - Funding Information:
This work was supported by National Institutes of Health (NIH) grant NIH-RO3AG042331 ; Jahnigen Career Development Award; Johns Hopkins Pepper Older Americans Independence Center ; NIA-P30AG021334 ; International Anesthesia Research Society; Johns Hopkins Clinician Scientist Award (Dr Brown); and NIH-RO1HL092259 (Dr Hogue). The authors wish to acknowledge Peter Rabins, Joseph Bienvenue, and Gregory Hobelmann for input on delirium consensus panels.
Publisher Copyright:
© 2016 The Society of Thoracic Surgeons.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Background Delirium is a common complication after cardiac surgical procedures and is associated with increased morbidity and mortality. However, whether rigorously assessed postoperative delirium is associated with an 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 or valve operations, or both, 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 were obtained 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%) versus no delirium (43%) had increased median LOS-ICU (75.6 hours [interquartile range (IQR): 43.6 to 136.8] vs. 29.7 hours [IQR: 21.7 to 46.0]; p = 0.002), increased median LOS (9 days [IQR: 6 to 16] vs. 7 days [IQR: 5 to 8]; p = 0.006), and increased median hospital charges ($51,805 [IQR: $44,041 to $80,238] vs. $41,576 [IQR: $35,748 to $43,660]; p = 0.002). In propensity score models adjusted for patient-related and surgical characteristics and complications, the results for LOS-ICU and cost remained highly significant, although the results for LOS were attenuated on the basis of the specific statistical model. Increased severity of delirium was associated with both increased LOS-ICU and increased charges in a dose-response manner. Conclusions Delirium after cardiac surgical procedures is independently associated with both increased LOS-ICU and higher hospital charges. Because delirium is potentially preventable, targeted delirium-prevention protocols for high-risk patients may represent an important strategy for quality improvement.
AB - Background Delirium is a common complication after cardiac surgical procedures and is associated with increased morbidity and mortality. However, whether rigorously assessed postoperative delirium is associated with an 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 or valve operations, or both, 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 were obtained 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%) versus no delirium (43%) had increased median LOS-ICU (75.6 hours [interquartile range (IQR): 43.6 to 136.8] vs. 29.7 hours [IQR: 21.7 to 46.0]; p = 0.002), increased median LOS (9 days [IQR: 6 to 16] vs. 7 days [IQR: 5 to 8]; p = 0.006), and increased median hospital charges ($51,805 [IQR: $44,041 to $80,238] vs. $41,576 [IQR: $35,748 to $43,660]; p = 0.002). In propensity score models adjusted for patient-related and surgical characteristics and complications, the results for LOS-ICU and cost remained highly significant, although the results for LOS were attenuated on the basis of the specific statistical model. Increased severity of delirium was associated with both increased LOS-ICU and increased charges in a dose-response manner. Conclusions Delirium after cardiac surgical procedures is independently associated with both increased LOS-ICU and higher hospital charges. Because delirium is potentially preventable, targeted delirium-prevention protocols for high-risk patients may represent an important strategy for quality improvement.
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U2 - 10.1016/j.athoracsur.2015.12.074
DO - 10.1016/j.athoracsur.2015.12.074
M3 - Article
C2 - 27041454
AN - SCOPUS:84962108515
SN - 0003-4975
VL - 101
SP - 1663
EP - 1669
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -