Delirium in Postoperative Patients Admitted to the Intensive Care Unit.

Jul 9, 2018The American surgeon

Delirium in Patients After Surgery in the Intensive Care Unit

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Circadian Biology on OpenScience ↗PubMed ↗

Abstract

Of 6,338 surgical patients, 9.6% were identified with postoperative delirium using CAM-ICU screening, compared to only 0.9% identified through administrative records.

Postoperative delirium (POD) is linked to increased length of stay in the ICU and hospital, as well as higher mortality rates.
Preexisting dementia is significantly associated with POD, with an odds ratio of 6.47.
Older age and major comorbidities, such as congestive heart failure and chronic pulmonary disease, are also associated with increased POD risk.
Longer surgical durations, emergency surgeries, blood transfusions, and postoperative ventilation are correlated with higher POD rates.
CAM-ICU screening is more effective in identifying POD cases than administrative coding methods.

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Postoperative delirium (POD) is common among surgical patients admitted to the intensive care unit (ICU) and is associated with increased resource utilization, morbidity, and death. Our primary aim was to compare rates of POD using administrative International Classification of Diseases, Ninth Revision, records and automated interrogation of electronic health records from Confusion Assessment Method for the ICU (CAM-ICU) screening. The secondary aim was to assess POD risk associated with patient and perioperative characteristics. Electronic health records of surgical patients admitted to the ICU during 2011 through 2014 were abstracted for POD assessment by CAM-ICU and by administrative codes, Charlson comorbidity index, surgical characteristics, and Acute Physiology, Age, Chronic Health Evaluation III scores. Of 6338 patients, CAM-ICU identified 606 (9.6%) and administrative records identified 55 (0.9%) POD cases, with agreement on 50 cases. In multivariable logistic regression based on POD identified with CAM-ICU, preexisting dementia had the strongest association with POD (odds ratio [95% confidence interval], 6.47 [3.68-11.37]; P < 0.001). Other associations found were older age, congestive heart failure, chronic pulmonary disease, increased surgical duration, emergency cases, blood transfusions, postoperative ventilation, and higher Acute Physiology, Age, Chronic Health Evaluation III scores (all P ≤ 0.01). POD cases had lengthier ICU and hospital stays and a higher mortality rate (all P < 0.001). CAM-ICU scores identified higher rates of POD than a search for POD based on administrative codes. Preoperative presence of dementia and major comorbidities were associated with POD. Delirium in surgical patients is associated with worse outcomes.

Delirium in Postoperative Patients Admitted to the Intensive Care Unit.

Abstract

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