TY - JOUR
T1 - Delirium After Spine Surgery in Older Adults
T2 - Incidence, Risk Factors, and Outcomes
AU - Brown, Charles H.
AU - LaFlam, Andrew
AU - Max, Laura
AU - Wyrobek, Julie
AU - Neufeld, Karin J.
AU - Kebaish, Khaled M.
AU - Cohen, David B.
AU - Walston, Jeremy D.
AU - Hogue, Charles W.
AU - Riley, Lee H.
N1 - Publisher Copyright:
© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Objectives: To characterize the incidence, risk factors, and consequences of delirium in older adults undergoing spine surgery. Design: Prospective observational study. Setting: Academic medical center. Participants: Individuals aged 70 and older undergoing spine surgery (N = 89). Measurements: Postoperative delirium and delirium severity were assessed using validated methods, including the Confusion Assessment Method (CAM), CAM for the Intensive Care Unit, Delirium Rating Scale-Revised-98, and chart review. Hospital-based outcomes were obtained from the medical record and hospital charges from data reported to the state. Results: Thirty-six participants (40.5%) developed delirium after spine surgery, with 17 (47.2%) having purely hypoactive features. Independent predictors of delirium were lower baseline cognition, higher average baseline pain, more intravenous fluid administered, and baseline antidepressant medication. In adjusted models, the development of delirium was independently associated with higher quintile of length of stay (odds ratio (OR) = 3.66, 95% confidence interval (CI) = 1.48–9.04, P =.005), higher quintile of hospital charges (OR = 3.49, 95% CI = 1.35–9.00, P =.01), and lower odds of discharge to home (OR = 0.22, 95% CI = 0.07–0.69, P =.009). Severity of delirium was associated with higher quintile of hospital charges and lower odds of discharge to home. Conclusion: Delirium is common after spine surgery in older adults, and baseline pain is an independent risk factor. Delirium is associated with longer stay, higher charges, and lower odds of discharge to home. Thus, prevention of delirium after spine surgery may be an important quality improvement goal.
AB - Objectives: To characterize the incidence, risk factors, and consequences of delirium in older adults undergoing spine surgery. Design: Prospective observational study. Setting: Academic medical center. Participants: Individuals aged 70 and older undergoing spine surgery (N = 89). Measurements: Postoperative delirium and delirium severity were assessed using validated methods, including the Confusion Assessment Method (CAM), CAM for the Intensive Care Unit, Delirium Rating Scale-Revised-98, and chart review. Hospital-based outcomes were obtained from the medical record and hospital charges from data reported to the state. Results: Thirty-six participants (40.5%) developed delirium after spine surgery, with 17 (47.2%) having purely hypoactive features. Independent predictors of delirium were lower baseline cognition, higher average baseline pain, more intravenous fluid administered, and baseline antidepressant medication. In adjusted models, the development of delirium was independently associated with higher quintile of length of stay (odds ratio (OR) = 3.66, 95% confidence interval (CI) = 1.48–9.04, P =.005), higher quintile of hospital charges (OR = 3.49, 95% CI = 1.35–9.00, P =.01), and lower odds of discharge to home (OR = 0.22, 95% CI = 0.07–0.69, P =.009). Severity of delirium was associated with higher quintile of hospital charges and lower odds of discharge to home. Conclusion: Delirium is common after spine surgery in older adults, and baseline pain is an independent risk factor. Delirium is associated with longer stay, higher charges, and lower odds of discharge to home. Thus, prevention of delirium after spine surgery may be an important quality improvement goal.
KW - cost
KW - delirium
KW - outcomes
KW - spine surgery
UR - http://www.scopus.com/inward/record.url?scp=84992065348&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84992065348&partnerID=8YFLogxK
U2 - 10.1111/jgs.14434
DO - 10.1111/jgs.14434
M3 - Article
C2 - 27696373
AN - SCOPUS:84992065348
SN - 0002-8614
VL - 64
SP - 2101
EP - 2108
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 10
ER -